Cardioprotective effects of perioperative beta-blockade in vascular surgery patients: fact or fiction?

摘要

PURPOSE OF REVIEW: Perioperative beta-blockade remains a subject of debate. In this review, recent literature and current guidelines for perioperative beta-blockade in vascular surgery patients are discussed. RECENT FINDINGS: Available evidence suggests that perioperative beta-blockade may be beneficial in reducing cardiac events. However, in a recent large study, the incidences of stroke and mortality were increased in patients on perioperative beta-blockers. Large systematic reviews failed to demonstrate a net beneficial effect of perioperative beta-blockers. The 2009 American and the European guidelines for perioperative beta-blockade in vascular surgery disagree on the available evidence but do recommend beta-blockade for several indications. Most recent, Wallace and colleagues published a large-sized retrospective study, reporting a beneficial effect of the adoption of a protocol for perioperative beta-blockade. SUMMARY: Perioperative beta-blockade reduces cardiac events, but at the expense of increased risk for mortality and stroke. The guidelines seem to be eager to follow positive outcome studies, without considering the effects of beta-blockade on other organ systems. Perhaps the main reason for the reported cardioprotective effects of perioperative beta-blocker therapy should be sought in failing preoperative beta-blocker prophylaxis (irrespective of surgery).