For nearly 2 decades, β-blockers have been thought to reduce the risk of major adverse cardiovascular events during the perioperative period. Beginning with the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography trial1 in 1999, a series of studies have provided compelling evidence that patients undergoing high-risk operations should receive β-blockers before surgery.2 Given these findings, the Surgical Care Improvement Project required that all patients previously receiving β-blockers should receive their medication in the 24 hours before surgery. More recently, however, several large-scale studies have failed to reproduce these beneficial effects,3,4 and the Perioperative Ischemic Evaluation trial4 found increased mortality with the use of β-blockers before surgery.
Toppen W, Sareh S, Johansen D, Genovese B, Satou N, Shemin R, Benharash P. Addition of Statins to Treatment With β-Blockers to Improve Outcomes for Cardiac Surgery PatientsBeyond the Surgical Care Improvement Project. JAMA Surg. 2016;151(4):389-391. doi:10.1001/jamasurg.2015.4212