Cardiac events occur in 1% to 5% of patients undergoing non-cardiac surgery. Myocardial ischemia and nonfatal myocardial infarction constitute the most significant risk factors for mortality and cardiovascular morbidity, in patients with coronary artery disease.
Perioperative b- blockade has been reported to reduce the risk of perioperative cardiac complications. Seven multicentre randomized trials have evaluated the impact of perioperative b-blocker administration on incidence of cardiovascular events.The Study of Perioperative Ischemia Research Group, the DECREASE and the BBSA trials focused on high risk patients for perioperative complications. The POBBLE, MaVS, and DIPOM trials did not target at patients with specific clinical risk factors, except DIPOM that included patients with diabetes. Finally, the POISE trial randomized patients with a wide variety of risk factors for perioperative cardiac complications. Interestingly, five meta-analyses reported a significant reduction in patients receiving b-blockers, with respect to perioperative myocardial ischemia and myocardial infarction.
In conclusion, consistent evidence demonstrated a reduction in cardiac mortality and myocardial infarction by perioperative b-blockade in patients with clinical risk factors, undergoing high-risk non-cardiac surgery. However, patients with extensive preoperative ischemia were at high risk of perioperative cardiac complications, despite b-blocker therapy. Conversely, perioperative b-blocker therapy did not reduce the incidence of cardiac complications in patients without clinical risk factors. While, the safety and effectiveness of perioperative b-blockers in intermediate-risk patients, still remain a debatable issue.
Keywords: B-blockers, non-cardiac surgery, myocardial ischemia, myocardial infarction, clinical trials, cardiac mortality.
Regulation of Cardiac Nerves: A New Paradigm in The Management of Sudden Cardiac Death?
Current Medicinal Chemistry Bradykinin is Involved in the Mediation of Cardiac Nociception during Ischemia through Upper Thoracic Spinal Neurons
Current Neurovascular Research Poly(ADP-Ribose) Polymerase Inhibitors
Current Medicinal Chemistry Respiratory Gas Exchange During Exercise in Children with Congenital Heart Disease: Methodology and Clinical Concepts
Current Respiratory Medicine Reviews Would Polymorphic Variants of Dopamine-2 Receptor Gene (DRD2) and Serotonin Transporter Gene (SERT) be a Common Genetic Risk Factor for Comorbid Drug Abuse and Myocardial Ischemia? A Hypothesis- generating Study
Current Pharmacogenomics and Personalized Medicine (Formerly Current Pharmacogenomics) Untargeted Metabolomics in the Discovery of Novel Biomarkers and Therapeutic Targets for Atherosclerotic Cardiovascular Diseases
Cardiovascular & Hematological Disorders-Drug Targets Bone Marrow Stem Cell Therapy for Myocardial Angiogenesis
Current Vascular Pharmacology An Overview of the Effect of Weight Loss on Cardiovascular Autonomic Function
Current Diabetes Reviews Atheroma Burden and Morphology in Women
Current Pharmaceutical Design Impact of Aging on the Angiogenic Potential of the Myocardium: Implications for Angiogenic Therapies with Emphasis on Sirtuin Agonists
Recent Patents on Cardiovascular Drug Discovery (Discontinued) Contrast Media in Cardiovascular Magnetic Resonance
Current Pharmaceutical Design Provoking Neuroprotection by Peroxynitrite
Current Pharmaceutical Design Structure and Function of Poly(ADP-ribose) Polymerase-1: Role in Oxidative Stress-Related Pathologies
Current Vascular Pharmacology Opioid-induced Cardioprotection
Current Pharmaceutical Design Circadian Variation of Cardiovascular Events and Morning Blood Pressure Surge
Vascular Disease Prevention Hyperpolarized Metabolic MR in the Study of Cardiac Function and Disease
Current Pharmaceutical Design ATP-Sensitive K+ Channel Openers: Old Drugs with New Clinical Benefits for the Heart
Current Vascular Pharmacology Flavonols and Flavones – Protecting Against Myocardial Ischemia/ Reperfusion Injury by Targeting Protein Kinases
Current Medicinal Chemistry Reduction of Myocardial Ischemia-Reperfusion Injury with Pre- and Postconditioning: Molecular Mechanisms and Therapeutic Targets
Cardiovascular & Hematological Disorders-Drug Targets Cardioprotective Utility of Urocortin in Myocardial Ischemia- Reperfusion Injury: Where do We Stand?
Current Molecular Pharmacology