In the long-awaited DECREASE IV trial, 1066 intermediate risk (1-6% risk of peri-operative cardiac risk) patients undergoing elective non-cardiac surgery were initiated on bisoprolol 2.5 mg (goal HR 50-70 and SBP>100) +/- fluvastatin 80mg, a month before surgery. Bisoprolol was associated with a lower risk of 30 day cardiac death/MI (2% versus 6%), as was fluvastatin (3% versus 5%; but not statistically significant). There does appear to be a benefit to beta blockers in intermediate risk patients undergoing non-cardiac surgery, if started a month in advance and titrated to goal (abstract). This is different than the POISE trial, in which beta blockers were started immediately before surgery (which showed lowered rates of MI, but higher rates of mortality). For now, there does not appear to be a signficant advantage for statins in reducing peri-operative events.
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.