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ISCHAEMIC HEART DISEASE
Although suggestive small trials have been done, no large scale randomised trials have been undertaken to assess routine perioperative ß blockade to reduce cardiovascular risk. This study of "real life" assessed 782 969 patients, of whom 663 635 (85%) had no recorded contraindications to ß blockers, and 122 338 of whom (18%) received such treatment during the first two hospital days. High risk patients made up 44%, with a revised cardiac risk index (RCRI) score of 4 or higher. This index stratifies the risk of perioperative cardiac events according to the type of surgery and the presence or absence of a history of ischaemic heart disease, congestive heart failure, cerebrovascular disease, preoperative treatment with insulin, and a preoperative serum creatinine concentration > 2.0 mg/dl (176.8 µmol/l). The relation between perioperative ß blocker treatment and the risk of death varied directly with cardiac risk; among the 580 665 patients with an
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