Mise au point sur les ß-bloquants en 2009 dans la prévention des infarctus du myocarde péri-opératoire

Abstract

The peri-operative management of patients at high risk of cardiac complications consists in preoperative cardiac risk evaluation (stratification), in adequate peri-operative monitoring and in the management of cardioprotective treatments. Betablockers reduce cardiac oxygen consumption and the impact of rapidly changing physiologic responses during the stressful peri-operative period through their negative inotropic and chronotropic effects. On the contrary, the adverse effects of ß-blocker therapy such as bradycardia or hypotension may increase the risk of stroke and impair the long-term outcome. The results of some recent studies incite us to be careful in the peri-operative use of betablockers. The efficacy of peri-operative ß-blocker therapy appears to be related to the cardiac risk (Lee score ≥ 2), to a tight heart rate control achieved with titration of doses and to the correction of episodes of hypotension. The 2006 and 2007 ACC/AHA guidelines on perioperative ß-blocker therapy and management of patients with coronary artery disease are still valid. However, we have to wait to the results of recent large trials on betablockers to update the current recommendations.