Influence of beta-blockers on the outcome of at risk patients.

Present recommendations for perioperative ss-blockade are solely based on the findings of two randomized controlled trials of inadequate methodology and data analysis in just a little over 300 patients performed in the late 1990s. The PeriOperative ISchemic Evaluation study is the first adequately powered controlled randomized trial on the efficacy and safety of perioperative ss-blocker therapy. During the first 30 postoperative days, the primary endpoint (combined cardiovascular death, non-fatal myocardial infarction and cardiac arrest) was significantly less in the ss-blocker compared to the placebo group, primarily due to a marked reduction in the incidence of non-fatal myocardial infarctions. However, in the ss-blocker group total mortality and the incidence of stroke were higher, negating the beneficial effect of perioperative ss-blocker therapy on the primary endpoint. A recently published meta-analysis confirmed in large parts these findings. Based on these publications, most of the present recommendations for perioperative ss-blocker therapy are no longer supported by evidence and respective revision is needed.