a metaanalysis of safety and effectiveness of perioperative betablocker use for the prevention of cardiac events in different types of noncardiac surgery objective perioperative betablocker therapy has been proposed to improve outcome most of the trials conducted however lacked statistical power to evaluate the incidence of hard cardiac events and the relationship to the type of surgery therefore we conducted a metaanalysis of all randomized controlled trials in which betablocker therapy was evaluatedmethods an electronic search of published reports on medline was undertaken to identify studies published between january 1980 and november 2004 in english language journals all studies reported on at least one of three endpoints perioperative myocardial ischemia perioperative nonfatal myocardial infarction and cardiac mortality type of surgery defined as low intermediate and high risk according to the american college of cardiologyamerican heart association guidelines was notedresults in total 15 studies were identified which enrolled 1077 patient no significant differences were observed in baseline clinical characteristics between patients randomized to betablocker therapy and controlplacebo betablocker therapy was associated with a 65 reduction in perioperative myocardial ischemia 110 vs 256 odds ratio 035 95 confidence interval 023054 p0001 furthermore a 56 reduction in myocardial infarction 05 vs 39 odds ratio 044 95 confidence interval 020097 p004 and a 67 reduction 11 vs 61 odds ratio 033 95 confidence interval 017067 p0002 in the composite endpoint of cardiac death and nonfatal myocardial infarction were observed no statistical evidence was observed for heterogeneity in the treatment effect in subgroups according to type of surgery p for heterogeneity 02conclusion this metaanalysis shows that betablocker use in noncardiac surgical procedures is associated with a significant reduction of perioperative cardiac adverse events