β-blockers beneficial in some, but not all, ischemic heart disease patients undergoing non-cardiac surgery

Whether β-blockers reduce adverse events among patients with stable ischemic heart disease (IHD) undergoing non-cardiac surgery remains in debate. In this Danish study, the authors retrospectively identified 28,263 IHD patients who underwent non-cardiac surgeries and examined the association between pre-procedural β-blockers use and a major adverse cardiovascular event (MACE) defined as 30-day cardiac death, myocardial infarction (MI) and stroke. The cohort included 7,990 patients (28.3%) with heart failure and 12,601 (44.6%) with a history of MI.  Overall, 1,374 (4.9%) experienced a MACE. The risk for MACE was lower among patients treated with β-blockers in the setting of a history of heart failure (adjusted hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.66-0.91) but not among patients without heart failure (adjusted HR 1.11; 95% CI 0.92-1.13). Among patients without heart failure, use of β-blockers was associated with lower risk of MACE in patients with an MI in the prior 2 years (HR 0.54; 95% CI 0.37-0.78).

Conclusion: In this retrospective cohort study of patients with IHD, β-blocker use prior to non-cardiac surgery was associated with a lower 30-day risk for major adverse events among patients with heart failure or recent MI. However, lower risk patients without heart failure or recent MI did not appear to benefit from perioperative β-blocker use.  Questions about the optimal IHD risk-threshold for consideration of β-blocker use in the setting of non-cardiac surgery remain.

  •  Andersson C, Merie C, Jorgensen M, et al. Association of beta-blocker therapy with risks of adverse cardiovascular events and deaths in patients with ischemic heart disease undergoing noncardiac surgery: a Danish nationwide cohort study. JAMA Internal Medicine. Mar 2014;174(3):336-344.

Summarized by Steven M. Bradley and Supriya Shore