Department of Cardiology, The Fifth Central Hospital of Tianjin, Tianjin, China.
Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China.
Int J Surg. 2020 Apr;76:153-162. doi: 10.1016/j.ijsu.2020.02.041. Epub 2020 Mar 10.
It remains uncertain whether there is a benefit to perioperative beta-blocker use on outcomes after non-cardiac surgery. This meta-analysis aims to update the evidence regarding the associations between beta-blocker exposure and patient major short-term outcomes following non-cardiac surgery.
Pubmed, Embase, and the Cochrane Central Register from their inception to May 2019 were searched by two independent authors. Observational studies reporting associations between perioperative beta-blocker treatment and short-term outcomes including 30-day all-cause mortality (ACM), 30-day major adverse cardiovascular events (MACE) and 30-day stroke risk were selected for inclusion. Meta-analyses were carried out by using random effects models.
Nineteen studies with a total of 1,711,766 participants were identified. Beta-blocker exposure was associated with reduced 30-day all-cause mortality (ACM) (RR 0.83, 95% CI 0.72 to 0.96). No evidence of publication bias was observed. Subgroup analyses revealed that significant 30-day survival benefits were observed in prospective, population-based studies, drug exposure period last till 1-2 months after surgery, patients having abdominal gastrointestinal surgery or having 3-4 cardiac risk factors. Beta-blocker exposure was associated with increased 30-day ACM among patients with no cardiac risk factors (RR 1.30, 95% CI 1.19 to 1.43). However, meta-analysis demonstrated a non-significant risk reduction in 30-day MACE (RR 1.03; 95% CI 0.85 to 1.25) or 30-day stroke risk (RR 0.86; 95% CI 0.44 to 1.68) with beta-blocker exposure.
The results of the current meta-analysis indicate beta-blocker exposure may be a significant indicator for 30-day ACM, but not for 30-day MACE or 30-day stroke risk. The association between beta-blocker exposure and long-term outcomes deserves further investigation.
围手术期使用β受体阻滞剂是否能改善非心脏手术后的结局仍不确定。本 meta 分析旨在更新有关围手术期使用β受体阻滞剂与非心脏手术后患者短期主要结局之间关联的证据。
两位独立作者检索了 Pubmed、Embase 和 Cochrane 中央注册库，检索时间从建库至 2019 年 5 月。纳入了报告围手术期β受体阻滞剂治疗与短期结局（包括 30 天全因死亡率（ACM）、30 天主要不良心血管事件（MACE）和 30 天卒中风险）之间关联的观察性研究。使用随机效应模型进行 meta 分析。
共纳入 19 项研究，总计 1711766 名参与者。β受体阻滞剂暴露与降低 30 天全因死亡率（ACM）相关（RR 0.83，95%CI 0.72 至 0.96）。未观察到发表偏倚的证据。亚组分析显示，前瞻性、基于人群的研究、药物暴露期持续至术后 1-2 个月、腹部胃肠道手术或存在 3-4 个心脏危险因素的患者中，观察到 30 天生存获益显著。β受体阻滞剂暴露与无心脏危险因素的患者 30 天 ACM 增加相关（RR 1.30，95%CI 1.19 至 1.43）。然而，meta 分析显示，β受体阻滞剂暴露与 30 天 MACE（RR 1.03；95%CI 0.85 至 1.25）或 30 天卒中风险（RR 0.86；95%CI 0.44 至 1.68）降低无显著相关性。
本 meta 分析结果表明，β受体阻滞剂暴露可能是 30 天 ACM 的重要指标，但不是 30 天 MACE 或 30 天卒中风险的指标。β受体阻滞剂暴露与长期结局之间的关联值得进一步研究。
