Poldermans et. al. (N Engl J Med 1999; 341: 1789-94)
is a really important study and every anesthesiologist, cardiologist,
surgeon, hospitalist, and internist should read it in detail.
This is a prospective, randomized, multi-centered trial which
assessed the effect of perioperative beta blockade on death. Bisoprolol
reduces the perioperative incidence of death from cardiac causes
and nonfatal myocardial infarction in high-risk patients who are
undergoing major vascular surgery. The risk of death was reduced
10 fold. The risk of death in patients with high risk of coronary
artery disease and good indications for CABG surgery who were
treated with beta blockers and then underwent non-cardiac surgery
was lower than the risk of the CABG. In high risk patients who
underwent CABG there was a 50% mortality. This paper is the key
element in perioperative beta blockers. Poldermans et.al. has
demonstrated that the risk of treating patients with the highest
risk for cardiac events with medical therapy and then undergoing
major vascular surgery is less than the risk of myocardial revascularization
with CABG.
In subsequent work Poldermans found that perioperative
beta blockade reduced two year mortality in a similar fashion
to Mangano et. al. 1996 (perioperative beta blockers) and Wallace
et. al. 2004. (perioperative clonidine).
