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Invited Commentary
March 2014

Perioperative β-Blockers RevisitedGood for What Ails You?

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
JAMA Intern Med. 2014;174(3):345-346. doi:10.1001/jamainternmed.2013.11341

The cardiovascular benefit of perioperative β-blockers for patients undergoing noncardiac surgery has been the subject of debate for more than 2 decades. In recent years, the controversy has been renewed by conflicting results of studies that have shown both protective and harmful effects. A recent meta-analysis by Bouri et al1 of 9 trials including 10 529 patients demonstrated an increased risk of 30-day mortality among patients administered a β-blocker, with a risk ratio (RR) of 1.27 (95% CI, 1.01-1.60). In the largest and perhaps most widely publicized trial included in that analysis, the PeriOperative ISchemic Evaluation (POISE) trial showed that in 8351 patients with coronary heart disease undergoing noncardiac surgery, those randomized to 200 mg of extended-release metoprolol succinate had an increased 30-day mortality, with a hazard ratio (HR) of 1.33 (95% CI, 1.03-1.74).2 In contrast, a retrospective cohort analysis of 37 805 propensity-matched pairs from the Veterans Affairs medical centers showed that patients undergoing noncardiac surgery who received β-blockers had a lower 30-day mortality, with an RR of 0.73 (95% CI, 0.65-0.83).3

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