Author Affiliations: Divisions of General Internal Medicine (Drs Chopra and Eagle) and Cardiovascular Medicine (Dr Eagle), University of Michigan Health System, Ann Arbor.
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?
Chopra V, Eagle KA. Perioperative β-Blockers for Cardiac Risk ReductionTime for Clarity. JAMA. 2010;303(6):551-552. doi:10.1001/jama.2010.68