Perioperative medikamentöse kardioprotektion: Systematische literaturübersicht als rationale grundlage zur prozessoptimierung

Patients with major cardiac risk factors have been suggested to benefit from perioperative β-blockade. However, the scientific literature on perioperative β-blockade needs to be interpreted carefully. So far treatment recommendations for millions of patients are based on heterogeneous data from randomized trials with divergent study results. The evidence for a beneficial effect of perioperative β-blockers is sufficient only for a limited subpopulation of high cardiac risk patients undergoing vascular surgery. Perioperative β-blocker treatment is not useful in patients with intermediate risk and may even be harmful in patients with low cardiac risk. Therefore, an individualized risk-benefit analysis is an important prerequisite for a rational therapy that may be based on a standardized protocol including the Revised Cardiac Risk Index. Such a protocol is presented in this article. A recently reported trial (POISE) demonstrated that perioperative treatment with high doses of oral metoprolol efficiently reduces the incidence of cardiovascular events. However, due to severe adverse effects (hypotension, bradycardia, stroke) the total mortality was increased. Thus, dose adjustments, safety aspects, and monitoring of β-blocker therapy seem to be mandatory. So far evidence from relevant trials about how to best implement perioperative β-blockade is lacking. This article offers a simple clinical concept for this purpose.