الفهرس 
M YOCARDIAL I NFARCTIONOnly 14 pages are availabe for public view
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Abstract
We searched Pubmed and Embase for randomised controlled trials investigating the use of β blockers in non-cardiac surgery. We extracted data for 30-day all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, heart failure, and myocardial ischaemia, safety outcomes of perioperative bradycardia, hypotension, and bronchospasm 33 trials included 12 306 patients. β blockers were not associated with any significant reduction in the risk of all-cause mortality, cardiovascular mortality, or heart failure, but were associated with a decrease (odds ratio [OR] 0·65, 95% CI 0·54–0·79) in non-fatal myocardial infarction (number needed to treat [NNT] 63) and decrease (OR 0·36, 0·26–0·50) in myocardial ischaemia (NNT 16) at the expense of an increase (OR 2·01, 1·27–3·68) in non-fatal strokes (number needed to harm [NNH] 293). The beneficial effects were driven mainly by trials with high risk of bias. For the safety outcomes, β blockers were associated with a high risk of perioperative bradycardia requiring treatment (NNH 22), and perioperative hypotension requiring treatment (NNH 17). We recorded no increased risk of bronchospasm.
Evidence does not support the use of β-blocker therapy for the prevention of perioperative clinical outcomes in patients having non-cardiac surgery. β blockers seem to increase the risk of stroke and possibly all-cause mortality but decrease the risk of non-fatal myocardial infarction. In view of the increased risk of stroke, bradycardia, and hypotension (which were independent predictors of death in the POISE trial), β blockers should not be routinely used for perioperative treatment of patients undergoing non-cardiac surgery unless patients are already taking them for clinically indicated reasons (heart failure, coronary artery disease, previous myocardial infarction.