Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery
Authors: P.J. Devereaux, Gordon Guyatt, Salim Yusuf
Journal: Annals of Internal Medicine (2011)

Letters4 October 2011Perioperative Myocardial Infarction in Patients Undergoing Noncardiac SurgeryP.J. Devereaux, MD, PhD, Gordon Guyatt, MD, MSc, and Salim Yusuf, MBBS, DPhilP.J. Devereaux, MD, PhDFrom Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada; McMaster University, Hamilton, Ontario L8N 3Z5, Canada; and Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada.Search for more papers by this author, Gordon Guyatt, MD, MScFrom Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada; McMaster University, Hamilton, Ontario L8N 3Z5, Canada; and Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada.Search for more papers by this author, and Salim Yusuf, MBBS, DPhilFrom Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada; McMaster University, Hamilton, Ontario L8N 3Z5, Canada; and Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-7-201110040-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Potyk states that we did not comment on the effects of perioperative β-blockade. On the basis of all the β-blocker trials in patients undergoing noncardiac surgery, there is strong evidence that β-blockade prevents perioperative MI. Contrary to Dr. Potyk's statement, perioperative β-blockade probably increases the risk for death and almost certainly increases the risk for stroke (1, 2). Our interpretation of these data is that controlling the sympathetic system in the perioperative setting is beneficial, but we need to find a way to do it safely and practically.Dr. Potyk believes that it is not necessary to ...References1. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, et al; POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839-47. [PMID: 18479744] CrossrefMedlineGoogle Scholar2. Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH. Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet. 2008;372:1962-76. [PMID: 19012955] CrossrefMedlineGoogle Scholar3. Levy M, Heels-Ansdell D, Hiralal R, Bhandari M, Guyatt G, Yusuf S, et al. Prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurement after noncardiac surgery: a systematic review and meta-analysis. Anesthesiology. 2011;114:796-806. [PMID: 21336095] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: P.J. Devereaux, MD, PhD; Gordon Guyatt, MD, MSc; Salim Yusuf, MBBS, DPhilAffiliations: From Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada; McMaster University, Hamilton, Ontario L8N 3Z5, Canada; and Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada.Note: Drs, Devereaux, Guyatt, and Yusuf are responding on behalf of the POISE investigators.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2129. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCharacteristics and Short-Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery P.J. Devereaux , Denis Xavier , Janice Pogue , Gordon Guyatt , Alben Sigamani , Ignacio Garutti , Kate Leslie , Purnima Rao-Melacini , Sue Chrolavicius , Homer Yang , Colin MacDonald , Alvaro Avezum , Luc Lanthier , Weijiang Hu , and Salim Yusuf , on behalf of the POISE (PeriOperative ISchemic Evaluation) InvestigatorsPerioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery Darryl Potyk Metrics 4 October 2011Volume 155, Issue 7Page: 477-478KeywordsAdjusted odds ratioDeath ratesDecision makingDisclosureMortalityMyocardial infarctionStatinsStrokeSurgeryTroponin ePublished: 4 October 2011 Issue Published: 4 October 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...