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Expert Rev Cardiovasc Ther. 2009 May;7(5):521-32. doi: 10.1586/erc.09.28.

Prevention of acute coronary events in noncardiac surgery: beta-blocker therapy and coronary revascularization.

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1
Department of Vascular Surgery, Erasmus Medical Center, Room H921, 's-Gravendijkwal 230, 3015 GE, Rotterdam, The Netherlands.

Abstract

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. beta-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 beta-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 beta-blocker therapy and prophylactic coronary revascularization.

PMID:
19419260
DOI:
10.1586/erc.09.28
[Indexed for MEDLINE]
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