The study by Poldermans in high-risk patients had to be stopped early because β-blockade proved so beneficial.
Subsequent studies have failed to reproduce these results.
Recent meta-analysis concluded that β-blockade ↓arrhythmias and myocardial ischaemia but had no effect on mortality, MI rate or length of hospital stay.
POISE study (large randomised multicentre trial - metoprolol started a few hours before surgery and continued for 30 days) showed ↓ MI and AF but ↑ mortality and stroke.
Stroke was associated with the hypotension caused by ß-blockade.
May have been better results if patients had been established on them earlier.
The best regimen in terms of patient selection, timing and duration of treatment is uncertain.
Worse outcome if patients on ß-blockers have them stopped.
Patients with IHD should be on ß-blockers already.
Don’t stop them if on and don’t start them shortly before surgery if not on them already.