β-blockers and risk of all-cause mortality in non-cardiac surgery:

Myocardial ischemia is a frequent complication in patients undergoing non-cardiac surgery and β-blockers may exert a protective effect. The main benefit of β-blockers in perioperative cardiovascular morbidity and mortality is believed to be linked to specific effects on myocardial oxygen supply and demand. β-blockers may exert anti-inflammatory and anti-arrhythmic effects. Randomized clinical trials which evaluated the effects of β-blockers on all-cause mortality in patients undergoing non-cardiac surgery have yielded conflicting results. In 9 trials, 10,544 patients with non-cardiac surgery were randomized to β-blockers (n = 5274) or placebo (n = 5270) and there were a total of 304 deaths. Patients randomized to β-blockers group showed a 19% increased risk of all-cause mortality (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.95-1.50; p = 0.135). However, trials included in the meta-analysis differed in several aspects, and a significant degree of heterogeneity (I 2 = 46.5%) was noted. A recent ana...