title: Beta-blocker use and clinical outcomes after primary vascular surgery: a nationwide propensity score-matched study.
abstract: OBJECTIVE
  To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.
  
  
  METHODS
  Patients who had primary vascular surgical or endovascular reconstruction due to symptomatic peripheral arterial disease, in Denmark between 1996 and 2007 were included. We obtained data on filled prescriptions, clinical outcomes and confounding factors from population-based healthcare registries. Beta-blocker users were matched to non-users by propensity score, and Cox-regression was performed. All medications were included as time-dependent variables.
  
  
  RESULTS
  We studied 16,945 matched patients (7828 beta-blocker users and 9117 non-users) with a median follow-up period of 582 days (range, 30-4379 days). The cumulative risks were as follows: all-cause mortality, 17.9%; MI, 5.3%; stroke, 5.6%; major amputation, 9.1%; and recurrent vascular surgery, 23.1%. When comparing beta-blocker users with non-users: adjusted hazard ratio: MI, 1.52 (95% CI, 1.31-1.78); stroke, 1.21 (95% CI, 1.03-1.43); and major amputation, 0.80 (95% CI, 0.70-0.93).
  
  
  CONCLUSIONS
  Beta-blocker use after primary vascular surgery was associated with a lower risk of major amputation but an increased risk of hospitalisation with MI and stroke. No associations were found between beta-blocker use and all-cause mortality or the risk of recurrent vascular surgery. However, our results are not sufficient to alter the indication for beta-blocker use among symptomatic peripheral arterial disease patients.
authors: Department of Vascular Surgery, Cardiovascular Research Unit, Viborg Regional Hospital, Denmark. Annette.hoegh@viborg.rm.dk
authors: A
authors: A
authors: Høgh
authors: J S
authors: JS
authors: Lindholt
authors: H
authors: H
authors: Nielsen
authors: L P
authors: LP
authors: Jensen
authors: S P
authors: SP
authors: Johnsen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D011446:Prospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000319:Adrenergic beta-Antagonists