Intercurrent drug therapy and perioperative cardiovascular mortality in elective and urgent/emergency surgical patients

The Oxford Record Linkage Study (ORLS; an epidemiological database) was use d to examine relationships between intercurrent cardiovascular drug therapy and cardiac death within 30 days of elective or emergency/urgent surgery u nder general anaesthesia. Cases identified from the ORLS were paired with m atched control patients. Clinical details were obtained from the patients' medical notes. In elective surgical patients, there was no effect of beta - adrenoceptor or calcium entry channel blockade, diuretics or digoxin on car diac death after adjusting for confounding variables. Use of nitrates was a ssociated with an odds ratio of 4.79 [95% confidence interval (CI) 1.01-22. 72] for cardiac death after adjustment for confounding by a history of angi na and residual age difference. In emergency/urgent patients, there were si gnificant univariate associations with cardiac death for intercurrent use o f angiotensin converting enzyme (ACE) inhibitors (odds ratio 1.18) and diur etics (odds ratio 4.95; 95% CI 1.82-13.46). However, neither maintained sig nificance after adjustment for the confounding effect of cardiac failure. W e conclude that, with the possible exception of the use of nitrates in elec tive surgical patients, chronic intercurrent drug treatment alone does not significantly affect the odds of cardiac death within 30 days of surgery.