Table 11

Perioperative Prophylactic Beta Blockers and Anti-Ischemic Medications

StudyProcedurenControlDrug and DosageMyocardial IschemiaMIDeath
ControlDrugControlDrugControlDrug
Studies of Beta Blockers
 Pasternack et al., 1987 (374)Abdominal aortic aneurysmorrhaphy83Case-controlMetoprolol 50 mg PO preoperatively17.6% (9/51)3.1% (1/32)
 Pasternack et al., 1989 (78)Vascular200UnblindedMetoprolol 50 mg PO preoperatively1.8±3.2 episodes0.8±1.6 episodes
 Stone et al., 1988 (75)Noncardiac128Placebo
  • Labetalol

  • Atenolol

  • Alprenolol

  • PO preoperatively

28.2% (11/39)2.2% (2/89)0% (0/39)0% (0/89)
 Poldermans et al., 1999 (88)Vascular112UnblindedBisoprolol 5 to 10 mg PO17% (9/53)0% (0/59)17% (9/53)3.4% (2/59)
 Raby et al., 1999 (376)Vascular26PlaceboIV esmolol72.7% (8/11)33.3% (5/15)
 Wallace et al., 1998 (381) and Mangano et al., 1996 (87)Noncardiac200PlaceboAtenolol 10 to 20 mg IV or 50 to 100 mg PO39/101 (38.6%)24/99 (24.2%)(At 6 months)10/101 (9.9%)1/99 (1.0%)
 Urban et al., 2000 (382)Noncardiac107PlaceboIV esmolol on the day of surgery, followed by metoprolol starting at 25 mg PO BID and increased to maintain an HR less than 80 bpm, and continued for the next 48 h14.5% (8/55)5.8% (3/52)5.4% (3/55)1.9% (1/52)
 Brady et al., 2005 (379)Vascular103PlaceboMetoprolol 50 mg PO BID preoperatively until 7 d after surgery9% (4/44)9.4% (5/53)11.3% (5/44)5.6% (3/53)2.2% (1/44)5.6% (3/53)
Perioperative Prophylactic Anti-Ischemic Medications and Cardiac Morbidity
 Juul et al., 2006 (372)Noncardiac921PlaceboMetoprolol 100 mg sustained release 1 d preoperatively, until up to 8 d postoperatively16% (72/459)16% (74/462)
 Yang et al., 2006 (373)Vascular496PlaceboWeight-adjusted metoprolol, 50, 75, or 100 mg21/250 (8.4%)19/246 (7.7%)4/250 (1.6%)0/246 (0%)

BID indicates twice per day; bpm, beats per minute; HR, heart rate; IV, intravenous; MI, myocardial infarction; n, number of patients; NTG, nitroglycerin; and PO, by mouth.

  • p<0.05 for drug versus control.