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February 10, 2010

Perioperative β-Blockers for Cardiac Risk ReductionTime for Clarity

Author Affiliations

Author Affiliations: Divisions of General Internal Medicine (Drs Chopra and Eagle) and Cardiovascular Medicine (Dr Eagle), University of Michigan Health System, Ann Arbor.

JAMA. 2010;303(6):551-552. doi:10.1001/jama.2010.68

Perioperative cardiac events are common and thought to result from coronary plaque rupture, myocardial oxygen supply-demand mismatch, or a combination of these processes.1 In theory, β-blockers are ideal for preventing these events, because they decrease myocardial oxygen requirements (by lowering heart rate and reducing blood pressure) and are thought to stabilize atherosclerotic plaque.2 However, perioperative β-blockade has become controversial because of conflicting results of recent studies. Based on the latest evidence, the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) restricted the once-broad class I indication for perioperative β-blockers to only patients already receiving this therapy.3 Why has the evidence not provided clarity?

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