β-Blockade in Noncardiac Surgery: Outcome at All Levels of Cardiac Risk

Hypothesis We hypothesized that the relationship among β-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk. Design Retrospective cohort study. Setting Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Patients Among all patients who underwent various noncardiac surgical procedures in 2000, those who received perioperative β-blockers were matched and compared with a control group from the same patient population. Main Outcome Measures Thirty-day stroke, cardiac arrest, myocardial infarction, and mortality, as well as mortality at 1 year. Results Patients at all levels of cardiac risk who received β-blockers had lower preoperative and intraoperative heart rates. The β-blocker group had higher rates of 30-day myocardial infarction (2.94% vs 0.74%, P  =.03) and 30-day mortality (2.52% vs 0.25%, P  =.007) compared with the control group. In the β-blocker group, patients who died perioperatively had significantly higher preoperative heart rate (86 vs 70 beats/min, P  =.03). None of the deaths occurred among the patients at high cardiac risk. Conclusion Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of β-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.