title: Neuraxial block, death and serious cardiovascular morbidity in the POISE trial.
abstract: BACKGROUND
  This post hoc analysis aimed to determine whether neuraxial block was associated with a composite of cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal cardiac arrest within 30 days of randomization in POISE trial patients.
  
  
  METHODS
  A total of 8351 non-cardiac surgical patients at high risk of cardiovascular complications were randomized to β-blocker or placebo. Neuraxial block was defined as spinal, lumbar or thoracic epidural anaesthesia. Logistic regression, with weighting using estimated propensity scores, was used to determine the association between neuraxial block and primary and secondary outcomes.
  
  
  RESULTS
  Neuraxial block was associated with an increased risk of the primary outcome [287 (7.3%) vs 229 (5.7%); odds ratio (OR), 1.24; 95% confidence interval (CI), 1.02-1.49; P=0.03] and MI [230 (5.9%) vs 177 (4.4%); OR, 1.32; 95% CI, 1.07-1.64; P=0.009] but not stroke [23 (0.6%) vs 32 (0.8%); OR, 0.76; 95% CI, 0.44-1.33; P=0.34], death [96 (2.5%) vs 111 (2.8%); OR, 0.87; 95% CI, 0.65-1.17; P=0.37] or clinically significant hypotension [522 (13.4%) vs 484 (12.1%); OR, 1.13; 95% CI, 0.99-1.30; P=0.08]. Thoracic epidural with general anaesthesia was associated with a worse primary outcome than general anaesthesia alone [86 (12.1%) vs 119 (5.4%); OR, 2.95; 95% CI, 2.00-4.35; P<0.001].
  
  
  CONCLUSIONS
  In patients at high risk of cardiovascular morbidity, neuraxial block was associated with an increased risk of adverse cardiovascular outcomes, which could be causal or because of residual confounding.
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia. kate.leslie@mh.org.au
authors.forename: K
authors.initials: K
authors.lastname: Leslie
authors.forename: P
authors.initials: P
authors.lastname: Myles
authors.forename: P
authors.initials: P
authors.lastname: Devereaux
authors.forename: E
authors.initials: E
authors.lastname: Williamson
authors.forename: P
authors.initials: P
authors.lastname: Rao-Melancini
authors.forename: A
authors.initials: A
authors.lastname: Forbes
authors.forename: S
authors.initials: S
authors.lastname: Xu
authors.forename: P
authors.initials: P
authors.lastname: Foex
authors.forename: J
authors.initials: J
authors.lastname: Pogue
authors.forename: M
authors.initials: M
authors.lastname: Arrieta
authors.forename: G
authors.initials: G
authors.lastname: Bryson
authors.forename: J
authors.initials: J
authors.lastname: Paul
authors.forename: M
authors.initials: M
authors.lastname: Paech
authors.forename: R
authors.initials: R
authors.lastname: Merchant
authors.forename: P
authors.initials: P
authors.lastname: Choi
authors.forename: N
authors.initials: N
authors.lastname: Badner
authors.forename: P
authors.initials: P
authors.lastname: Peyton
authors.forename: J
authors.initials: J
authors.lastname: Sear
authors.forename: H
authors.initials: H
authors.lastname: Yang
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009407:Nerve Block / Q000009:adverse effects* / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012307:Risk Factors; D016037:Single-Blind Method
keywords: anaesthesia, epidural; anaesthesia, spinal; death; myocardial infarction; stroke