TY - JOUR T1 - Cardiovascular highlights from non-cardiology journals JF - Heart JO - Heart SP - 1061 LP - 1062 DO - 10.1136/heartjnl-2013-304366 VL - 99 IS - 14 AU - Alistair C Lindsay Y1 - 2013/07/15 UR - http://heart.bmj.com/content/99/14/1061.abstract N2 - 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. Conclusions 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 … ER -