Bisoprolol insufficient to prevent perioperative myocardial injury during noncardiac surgery

Bisoprolol does not seem to exert a significant protective effect against perioperative myocardial injury in patients undergoing noncardiac surgery, a recent study has found.

Researchers conducted a randomized controlled analysis of 112 patients undergoing noncardiac surgery allocated to receive either bisoprolol (n=57) or placebo (n=55). Interventions were given at least 2 days before surgery and continued until 30 days after the procedure.

The primary outcome of myocardial injury was defined as a rise in high-sensitivity troponin-T (hs-TnT) levels >99th percentile of the upper reference limit or an increase of >20 percent.

Perioperative myocardial injury was detected in 30 patients in the bisoprolol arm and 27 patients in the placebo group, resulting in statistically comparable incidence rates (52.6 percent vs 49.1 percent, respectively; p=0.706). Median hs-TnT levels were likewise not significantly different between the two groups.

Restricting the analysis to participants with baseline elevations in hs-TnT (nine in the bisoprolol arm and 12 in the placebo group) yielded similar findings, with perioperative myocardial injury occurring at comparable rates (p=0.458). The same was true in the subgroup of patients with normal baseline hs-TnT (p=0.372).

Both placebo and bisoprolol likewise had comparable safety profile, yielding similar rates of serious adverse events and discontinuations. The only notable exception was intraoperative hypotension, which occurred in significant excess in the bisoprolol arm (70.2 percent vs 47.3 percent; p=0.017).