Preoperative care/Catalogs/Beta-blocker evidence table

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Randomized controlled trials with at least 100 total patients and at least one death.[1][2][3][4][5][6][7][8]
(See legend and notes at bottom on the table)
Patients Intervention Comparison Outcome Results
Mortality Stroke Beta-blocker toxicity
Rx Control Rx Control Rx Control

Decrease IV[1]
2009

1066 patients
* Vascular: <1%
* RCRI>2: 0%
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: 3%
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
* All had diabetes
* Vascular: 7%
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%
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%
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%
* 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%
Atenolol
* Target HR: > 55 bpm
Placebo 4% 2% Not reported Discontinuation of study drug due to ADRs
0% 0%
Notes:
  1. Color indicates statistically significant differences with green indicating benefit and red indicating harm.
  2. BBSA noted more ADRs among patients with abnormal beta1-adrenergic receptor alleles.
  3. Mavs had trend toward most benefit in RCRI=3.


References

  1. Jump up to: 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. Jump up to: 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. Jump up to: 3.0 3.1 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. Jump up to: 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. Jump up to: 5.0 5.1 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. Jump up to: 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. Jump up to: 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. Jump up to: 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]