Abstract
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.
Current Pharmaceutical Design
Title:Perioperative B-blockers in Non-cardiac Surgery: Actual Situation
Volume: 19 Issue: 22
Author(s): Ioanna Koniari and George Hahalis
Affiliation:
Keywords: B-blockers, non-cardiac surgery, myocardial ischemia, myocardial infarction, clinical trials, cardiac mortality.
Abstract: 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.
Export Options
About this article
Cite this article as:
Koniari Ioanna and Hahalis George, Perioperative B-blockers in Non-cardiac Surgery: Actual Situation, Current Pharmaceutical Design 2013; 19 (22) . https://dx.doi.org/10.2174/1381612811319220003
DOI https://dx.doi.org/10.2174/1381612811319220003 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Editorial (Thematic Issue: The Coronary Collateral Circulation – Past, Present and Future)
Current Cardiology Reviews Targeting Adhesion Molecules in Cardiovascular Disorders
Cardiovascular & Hematological Disorders-Drug Targets The Effects of Sevoflurane or Remifentanil on the Stress Response to Surgical Stimulus
Current Pharmaceutical Design Monitoring Therapeutic Anticoagulation with Low Molecular Weight Heparins: Is it Useful or Misleading?
Cardiovascular & Hematological Agents in Medicinal Chemistry Vasomotor Effects of Iodinated Contrast Media: Just Side Effects?
Current Vascular Pharmacology Angiogenic and Vascular Modulation by Extracellular Matrix Cleavage Products
Current Pharmaceutical Design The Role of P2Y<sub>12</sub> Receptor and Activated Platelets During Inflammation
Current Drug Targets Heme Oxygenase-1: A Potential Antihypertensive Target?
Current Hypertension Reviews Post-stroke Depression Therapy: Where are we now?
Current Neurovascular Research Molecular Chaperone ORP150 in ER Stress–related Diseases
Current Pharmaceutical Design Reduction of Oxidative/Nitrosative Stress in Brain and its Involvement in the Neuroprotective Effect of n-3 PUFA in Alzheimer’s Disease
Current Alzheimer Research Coronary Microcirculation in Ischemic Heart Disease
Current Pharmaceutical Design Bridging Innate Immunity and Myocardial Ischemia/Reperfusion Injury: The Search for Therapeutic Targets
Current Pharmaceutical Design Endothelial Dysfunction in Heart Failure: Mechanisms and Therapeutic Approaches
Current Vascular Pharmacology Role of Methylene Blue in Trauma Neuroprotection and Neuropsychiatric Diseases
CNS & Neurological Disorders - Drug Targets Antiplatelet Therapies: Aspirin at the Heart of New Directions
Cardiovascular & Hematological Disorders-Drug Targets Effects of Static Magnetic Fields on Blood Pressure in Animals and Humans
Current Hypertension Reviews Genetic Engineering in Allotransplantation of Vascularized Organs
Current Gene Therapy The Vascular Compartments of Neovascularization: Spotlight on the Microcirculation
Current Pharmaceutical Biotechnology The Effect of Serotonin 5-HT2 Receptor Inhibitor on Vasomotor Responses
Vascular Disease Prevention (Discontinued)