Beta-blockers could increase risk in noncardiac surgery

Many trials have suggested a protective role for beta-blockade in noncardiac surgery, and the current ACC/AHA guidelines recommend their use in high-risk patients.  However, preliminary results from the recent POISE (Perioperative Ischemic Evaluation (POISE) trial showed a higher incidence of total deaths and stroke in patients receiving peri-operative bera-blockade compared with placebo.

Kaafarani et al. performed a retrospective cohort study of 1238 patients undergoing noncardiac surgery at their institution, 238 of which received beta-blockers perioperatively.  The main outcome measures were the 30-day incidence of stroke, cardiac arrest, myocardial infarction, and mortality, in addition to mortality at one year.

Patients who received beta-blockers showed higher rates of 30-day myocardial infarction (2.94% vs 0.74%, p=.03) and 30-day mortality (2.52% vs 0.25%, p=0.007) compared with the control group.  Patients who died perioperatively that were on beta-blockers had a significantly higher heart rate (86 vs 70 beats/min, p=.03).  Of note, no deaths occured among patients considered at high cardiac risk.

Details regarding the cardiac risk stratification and matching process are not clearly described in this paper; a larger, prospective, contemporary study will be needed to add more credence to the results.  Nonetheless, the study fuels the ongoing debate about the use of peri-operative beta-blockade in noncardiac surgery, and hints towards the importance of good heart rate control when beta-blockers are used.

  • Kaafarani HMA, Atluri PV, Thornby J, et al. ß-blockade in noncardiac surgery. Outcome at all levels of cardiac risk. Arch Surg 2008; 143:940-944.
  • Rasmussen TE. ß-blockade in noncardiac surgery—invited critique. Arch Surg 2008; 143:944.