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General cardiology, molecular cardiology, interventional cardiology, electrophysiology
β-blockers lower mortality after non-cardiac surgery
The use of preoperative β-blockade to minimise the cardiovascular risks of noncardiac surgery has remained controversial for some time, and recent studies have suggested that preoperative β-blockade may be now decreasing as a result. The purpose of this study was to determine whether early preoperative exposure to β-blockers could influence 30-day postoperative outcomes in patients undergoing noncardiac surgery.
This was a retrospective analysis examining 136 745 patients (1:1 matched on propensity scores) who were given β-blockers on the day of or following major non cardiac surgery. 104 VA hospitals were involved. The main outcome measure was 30-day mortality and cardiac morbidity (cardiac arrest or Q-wave myocardial infarction).
55 138 (40.3%) of patients were exposed to β-blockers, with those undergoing vascular surgery most likely to receive β-blockade (66.7% of all patients undergoing vascular surgery). 1.1% of patients died and cardiac morbidity occurred among 0.9% of patients. After the propensity matching, β-blocker use was associated with lower mortality (relative risk 0.73, p<0.001). When stratified by cumulative numbers of Revised Cardiac Risk Index factors, β-blocker exposure was associated with significantly lower mortality in patients with 2, 3, and 4 risk factors, however this association was limited to patients undergoing nonvascular surgery. A lower rate of cardiac arrest and nonfatal Q-wave infarction was seen in patients given β-blockers (p<0.001), but this again was limited to non-vascular surgery only.
Following propensity matching, preoperative β-blockade was associated with lower rates of 30-day mortality in patients with 2 or more Revised Cardiac Risk Index Factors undergoing non-cardiac, non-vascular surgery.
▸ London MJ, Hur K, Schwartz GG, et al. Association of perioperative beta-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA …