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An Alternative View of Current Evidence in Support of Perioperative -Blockers

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with interest the studies by Siddiqui et al¹ and Lindenauer et al.² Each report has, as its raison d’être, the supposition that perioperative -blockade is the standard of care for the prevention of postoperative cardiac complications. Furthermore, both studies presume that physicians who do not prescribe -blockers are not practicing good perioperative medicine. We wish to express the contrarian view that the evidence supporting the recommendation for perioperative -blockade is insufficient and that a vast amount of research is still required in the field of perioperative risk reduction.

Two meta-analyses have pooled the data from randomized controlled studies of perioperative -blockade.^3-4 Although both groups of reviewers found statistically significant reductions in myocardial infarction (MI), the pooled effect estimates were heavily weighted by 2 studies. One study was an interim analysis of an unblinded trial of highly selected, high-risk vascular patients.⁵ In the second study,⁶ the in-hospital incidence of . . . [Full Text of this Article]

AUTHOR INFORMATION
W. Scott Beattie, MD, PhD, FRCPC; Duminda N. Wijeysundera, MD; Peter T. Choi, MD, MSc(Epid), FRCPC