Preoperative care/Catalogs/Beta-blocker evidence table
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| Patients | Intervention | Comparison | Outcome | Results | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mortality | Stroke | Beta-blocker toxicity | ||||||||
| Rx | Control | Rx | Control | Rx | Control | |||||
|
Decrease IV[1] |
1066 patients * Vascular: < 1% * RCRI ≥ 2: 100% |
Bisoprolol * Started a median of 34 days preop * Target HR: >50 bpm |
Open label | Mortality at 30 days | 1.9% | 3.0% | 0.8% | 0.6% | Heart failure, clinically significant bradycardia or hypotension | |
| 0.6% | 0.4% | |||||||||
| POISE[2] 2008 |
8351 patients * Vascular: 42% * RCRI ≥ 2: uncertain |
Metoprolol * Started day of surgery * Target HR: > 50 bpm |
Placebo | Mortality at two weeks | Overall | 1% | 0.5% | Clinically significant hypotension | ||
| 3.1% | 2.3% | 15% | 9.7% | |||||||
| Vascular pts | ||||||||||
| Significant benefit | ||||||||||
| BBSA[3] 2007 |
224 patients * Spinal anesthesia * Vascular: 1% * RCRI ≥ 2: uncertain |
Bisoprolol * Started day of surgery Target HR: > 50bpm |
Placebo | Mortality at one year | 0.9 | 0.9 | 1.8% | 1.8% | Hypotension: | |
| 0% | 2.7% | |||||||||
| DIPOM[4] 2006 |
921 patients * Vascular: 7% *RCRI > 2: uncertain * All had diabetes |
Metoprolol * Started 0-1 days preop * Target HR: >55 bpm |
Placebo | Mortality at a median of 18 months | 16% | 16% | 0.4% | 0% | Hypotension reported as an ADR | |
| 0.4% | 0.2% | |||||||||
| MaVS[5] 2006 |
496 patients * Vascular: 100% *RCRI ≥ 2: 40% |
Metoprolol *Start: day of surgery * Target HR: > 50 bpm while awake; >45 bpm while asleep. |
Placebo | Hospital mortality | 0% | 1.6% | Not reported | Intraoperative hypotension treated | ||
| 46% | 34% | |||||||||
| POBBLE[6] 2005 |
103 patients * Vascular: 100% *RCRI > 2: uncertain |
Metoprolol * Start with test dose one day preop * Target HR: > 50 bpm |
Placebo (anesthesiologists were not blinded) | Mortality at 30 days | 3% | 1% | 2% | 0% | Intraoperative inotropes given | |
| 92% | 64% | |||||||||
| Decrease[7] 1999 |
112 patients * Vascular surgery: 100% *RCRI ≥ 2: uncertain, at least 67% * Abnl stress echo: 100% |
Bisoprolol * Started a median of 37 days preop * Target HR: > 50 bpm |
Open label | Mortality at 30 days | 3.4 | 17.0 | Not reported | Discontinuation of study drug due to ADRs | ||
| 0% | 0% | |||||||||
| Wallace/ MSPI[8] 1996 |
200 patients * Vascular: 41% *RCRI > 2: uncertain |
Atenolol * Target HR: > 55 bpm |
Placebo | Hospital mortality | 4% | 2% | Not reported | Discontinuation of study drug due to ADRs | ||
| 0% | 0% | |||||||||
Notes:
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References
- ↑ 1.0 1.1 Dunkelgrun M, Boersma E, Schouten O, et al. (June 2009). "Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV)". Ann. Surg. 249 (6): 921–6. DOI:10.1097/SLA.0b013e3181a77d00. PMID 19474688. Research Blogging.
- ↑ 2.0 2.1 Devereaux PJ, Yang H, Yusuf S, et al. (May 2008). "Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial". Lancet 371 (9627): 1839–47. DOI:10.1016/S0140-6736(08)60601-7. PMID 18479744. Research Blogging.
- ↑ 3.0 3.1 3.2 Zaugg M, Bestmann L, Wacker J, et al. (July 2007). "Adrenergic receptor genotype but not perioperative bisoprolol therapy may determine cardiovascular outcome in at-risk patients undergoing surgery with spinal block: the Swiss Beta Blocker in Spinal Anesthesia (BBSA) study: a double-blinded, placebo-controlled, multicenter trial with 1-year follow-up". Anesthesiology 107 (1): 33–44. DOI:10.1097/01.anes.0000267530.62344.a4. PMID 17585213. Research Blogging.
- ↑ 4.0 4.1 Juul AB, Wetterslev J, Gluud C, et al. (June 2006). "Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial". BMJ 332 (7556): 1482. DOI:10.1136/bmj.332.7556.1482. PMID 16793810. PMC 1482337. Research Blogging.
- ↑ 5.0 5.1 5.2 Yang H, Raymer K, Butler R, Parlow J, Roberts R (November 2006). "The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial". Am. Heart J. 152 (5): 983–90. DOI:10.1016/j.ahj.2006.07.024. PMID 17070177. Research Blogging.
- ↑ 6.0 6.1 Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR (April 2005). "Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial". J. Vasc. Surg. 41 (4): 602–9. DOI:10.1016/j.jvs.2005.01.048. PMID 15874923. Research Blogging.
- ↑ 7.0 7.1 Poldermans D, Boersma E, Bax JJ, et al. (December 1999). "The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group". N. Engl. J. Med. 341 (24): 1789–94. PMID 10588963. [e]
- ↑ 8.0 8.1 Mangano DT, Layug EL, Wallace A, Tateo I (December 1996). "Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group". N. Engl. J. Med. 335 (23): 1713–20. PMID 8929262. [e]