I was curious what the attednings/ upper year residents thought of this study (May, Lancet). Basically, they reported a decreased incidence of MI but increased risk of (all cause) mortality in patients with CAD or risk factors who received perioperative metoprolol prior to noncardiac surgery(100mg given between 2-4 hours before surgery, 6h after, and then BID for 30 days, you can read the study for the details.) I know the consensus on perioperative beta blockade is frequently being augmented or changing with the recent studies popping up. What I would like to know is how you as attendings (or senior residents) will intepret and use this most recent study. Will you continue to abide strictly by the ACC/AHA guidelines (if you do currently), or will you change your practice. And do you think this study is even applicable as 100mg metoprolol bid is a pretty descent starting dose.