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REDUCING GLOBAL PERIOPERATIVE RISK


This resource center is jointly hosted by The American Journal of Medicine,
The American Journal of Cardiology, and the Canadian Journal of Cardiology.

Key Findings

KEY FINDINGS

  • Metoprolol reduced the risk of myocardial infarction but increased the risk of death and stroke. The negative outcomes appeared to occur through an increase in hypotension on surgical floors.
  • The POISE trial highlighted the risk in assuming a perioperative beta-blocker regimen has benefit without substantial harm, and the importance and need for large randomized trials in the perioperative setting.
  • Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol.

Key Guideline Recommendations

  • Brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) should be measured before surgery in patients who are ≥65 years of age, are 45 to 64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥1.
  • Physician should avoid performing preoperative resting echocardiography, coronary CT angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging.

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Funding for this site was received from the PHRI via support from the Canadian Institutes of Health Research’s Strategy for
Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care.