During major vascular surgery, patients are at high risk for developing myocardial infarction and myocardial ischemia, and two risk-reduction strategies can be considered prior to surgery: pharmacological treatment and prophylactic coronary revascularization. β-blockers are established therapeutic agents for patients with hypertension, heart failure and coronary artery disease. There is still considerable debate concerning the protective effect of β-blocker therapy towards perioperative coronary events, which will be outlined in this article. Two randomized, controlled trials suggest that coronary revascularization of cardiac-stable patients provides no benefits in the postoperative outcomes. In the current American College of Cardiology/ American Heart Association guidelines for 'Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery', routine prophylactic coronary revascularization is not recommended in patients with stable coronary artery disease. However, a recent retrospective, observational study suggests that intermediate-risk patients may benefit from preoperative coronary revascularization. The present article provides an extended overview of leading observational studies, randomized, controlled trials, meta-analyses and guidelines assessing perioperative β-blocker therapy and prophylactic coronary revascularization.

, , , , , , ,
doi.org/10.1586/erc.09.28, hdl.handle.net/1765/32708
Expert Review of Cardiovascular Therapy
Erasmus MC: University Medical Center Rotterdam

Flu, W.-J., van Kuijk, J.-P., Winkel, T., Hoeks, S., Bax, J., & Poldermans, D. (2009). Prevention of acute coronary events in noncardiac surgery: β-blocker therapy and coronary revascularization. Expert Review of Cardiovascular Therapy (Vol. 7, pp. 521–532). doi:10.1586/erc.09.28