Preoperative care/Catalogs/Beta-blocker evidence table: Difference between revisions

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|+[[Randomized controlled trial]]s with at least 100 total patients and at least one death.<ref name="pmid19474688">{{cite journal |author=Dunkelgrun M, Boersma E, Schouten O, ''et al.'' |title=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) |journal=Ann. Surg. |volume=249 |issue=6 |pages=921–6 |year=2009 |month=June |pmid=19474688 |doi=10.1097/SLA.0b013e3181a77d00 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-4932&volume=249&issue=6&spage=921 |issn=}}</ref>
|+ [[Randomized controlled trial]]s with at least 100 total patients and at least one death.<ref name="pmid19474688">{{cite journal |author=Dunkelgrun M, Boersma E, Schouten O, ''et al.'' |title=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) |journal=Ann. Surg. |volume=249 |issue=6 |pages=921–6 |year=2009 |month=June |pmid=19474688 |doi=10.1097/SLA.0b013e3181a77d00 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-4932&volume=249&issue=6&spage=921 |issn=}}</ref><ref name="pmid18479744">{{cite journal |author=Devereaux PJ, Yang H, Yusuf S, ''et al.'' |title=Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial |journal=Lancet |volume=371 |issue=9627 |pages=1839–47 |year=2008 |month=May |pmid=18479744 |doi=10.1016/S0140-6736(08)60601-7 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60601-7 |issn=}}</ref><ref name="pmid17585213">{{cite journal |author=Zaugg M, Bestmann L, Wacker J, ''et al.'' |title=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 |journal=Anesthesiology |volume=107 |issue=1 |pages=33–44 |year=2007 |month=July |pmid=17585213 |doi=10.1097/01.anes.0000267530.62344.a4 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-3022&volume=107&issue=1&spage=33 |issn=}}</ref><ref name="pmid16793810">{{cite journal |author=Juul AB, Wetterslev J, Gluud C, ''et al.'' |title=Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial |journal=BMJ |volume=332 |issue=7556 |pages=1482 |year=2006 |month=June |pmid=16793810 |pmc=1482337 |doi=10.1136/bmj.332.7556.1482 |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=16793810 |issn=}}</ref>
! rowspan="3"|&nbsp;!!rowspan="3"|Patients!! rowspan="3"|Intervention!! rowspan="3"|Comparison!! rowspan="3"|Outcome!! colspan="6"|Results
|-
|-
! colspan="2"|Mortality!!colspan="2"|Stroke!!colspan="2"|Beta-blocker toxicity
! rowspan="3" |
! rowspan="3" | Patients
! rowspan="3" | Intervention
! rowspan="3" | Comparison
! rowspan="3" | Outcome
! colspan="6" align="center" | Results
|-
|-
!Rx!!Control!!Rx!!Control!!Rx!!Control
! colspan="2" | Mortality
! colspan="2" | Stroke
! colspan="2" | Beta-blocker toxicity
|-
|-
| DECREASE-IV<ref name="pmid19474688"/><br/>2009||1066 patients<br/>* Vascular: <1%<br/>* RCRI>2: 0%||[[Bisoprolol]]<br/>* Started a median of 34 days preop<br/>* Target HR: >50 bpm|| Open label|| Mortality at 30 days|| cell|| cell|| cell|| cell|| cell|| cell
! Rx
! Control
! Rx
! Control
! Rx
! Control
|- style="height: 33.75pt"
| rowspan="2" |
Decrease IV<ref name="pmid19474688"/><br />2009
| rowspan="2" valign="top" | 1066 patients<br /> * Vascular: <1%<br /><nowiki>* RCRI>2: 0%</nowiki>
| rowspan="2" | Bisoprolol<br /><nowiki>* Started a median of 34 days preop</nowiki><br /><nowiki>* Target HR: >50 bpm</nowiki>
| rowspan="2" | Open label
| rowspan="2" | Mortality at 30 days
| rowspan="2" bgcolor="lime" align="center" | 1.9%
| rowspan="2" bgcolor="lime" align="center" | 3.0%
| rowspan="2" align="center" | 0.8%
| rowspan="2" align="center" | 0.6%
| colspan="2" | Heart failure, clinically significant bradycardia or hypotension
|-
|-
| cell || cell|| cell|| cell|| cell|| cell|| cell|| cell|| cell|| cell|| cell
| align="center" | 0.6%
| align="center" | 0.4%
|-
| rowspan="4" |POISE<ref name="pmid18479744"/><br />2008
| rowspan="4" valign="top" | 8351 patients<br /> * Vascular: 42%<br /><nowiki>* RCRI>2: uncertain</nowiki>
| rowspan="4" | Metoprolol<br /><nowiki>* Started day of surgery</nowiki><br /><nowiki>* Target HR: >50 bpm</nowiki>
| rowspan="4" | Placebo
| rowspan="4" | Mortality at two weeks
| colspan="2" | Overall
| rowspan="4" bgcolor="red" align="center" | 1%
| rowspan="4" bgcolor="red" align="center" | 0.5%
| colspan="2" | Clinically significant hypotension
|-
| align="center" | 3.1%
| align="center" | 2.3%
| rowspan="3" bgcolor="red" align="center" | 15%
| rowspan="3" bgcolor="red" align="center" | 9.7%
|-
| colspan="2" | Vascular pts
|-
| colspan="2" bgcolor="lime" | Significant benefit
|-
| rowspan="2" |BBSA<ref name="pmid17585213"/><br /> 2007
| rowspan="2" valign="top" | 224 patients<br /><nowiki>*Spinal anesthesia</nowiki><br /><nowiki>*Vascular: 1%</nowiki><br /><nowiki>* RCRI > 2: 3%</nowiki>
| rowspan="2" valign="top" | Bisoprolol<br /><nowiki>* Started day of surgery</nowiki><br />Target HR: > 50bpm
| rowspan="2" | Placebo
| rowspan="2" | Mortality at ''one year''
| rowspan="2" align="center" | 0.9
| rowspan="2" align="center" | 0.9
| rowspan="2" align="center" | 1.8%
| rowspan="2" align="center" | 1.8%
| colspan="2" | Hypotension:
|-
| align="center" | 0%
| align="center" | 2.7%
|-
| rowspan="2" |DIPOM<ref name="pmid16793810"/><br /> 2006
| rowspan="2" valign="top" | 921 patients<br /><nowiki>* All had diabetes</nowiki><br /><nowiki>* Vascular: 7%</nowiki>
| rowspan="2" valign="top" | Metoprolol<br /><nowiki>* Started 0-1 days preop</nowiki><br /><nowiki>* Target HR: >55 bpm</nowiki>
| rowspan="2" | Placebo
| rowspan="2" | Mortality at a median of ''18 months''
| rowspan="2" align="center" | 16%
| rowspan="2" align="center" | 16%
| rowspan="2" align="center" | 0.4%
| rowspan="2" align="center" | 0%
| colspan="2" | Hypotension reported as an ADR
|-
| align="center" | 0.4%
| align="center" | 0.2%
|-
| rowspan="2" |
[http://pubmed.gov/17070177 MaVS]<br />2006
| rowspan="2" valign="top" | 496 patients<br /><nowiki>* Vascular: 100%</nowiki>
| rowspan="2" valign="top" | Metoprolol<br /><nowiki>*Start: day of surgery</nowiki><br /><nowiki>* Target HR: > 50 bpm while awake;</nowiki><br />>45 bpm while asleep.
| rowspan="2" | Placebo
| rowspan="2" | Hospital mortality
| rowspan="2" align="center" | 0%
| rowspan="2" align="center" | 1.6%
| rowspan="2" colspan="2" align="center" | Not reported
| colspan="2" | Intraoperative hypotension treated
|-
| bgcolor="red" align="center" | 46%
| bgcolor="red" align="center" | 34%
|-
| rowspan="2" |
[http://pubmed.gov/15874923 POBBLE]<br />2005
| rowspan="2" valign="top" | 103 patients<br /><nowiki>* Vascular: 100%</nowiki>
| rowspan="2" valign="top" | Metoprolol<br /><nowiki>* Start with test dose one day preop</nowiki><br /><nowiki>* Target HR: > 50 bpm</nowiki>
| rowspan="2" | Placebo (anesthesiologists were not blinded)
| rowspan="2" | Mortality at 30 days
| rowspan="2" | 3%
| rowspan="2" | 1%
| rowspan="2" | 2%
| rowspan="2" | 0%
| colspan="2" | Intraoperative inotropes given
|-
| bgcolor="red" align="center" | 92%
| bgcolor="red" align="center" | 64%
|-
| rowspan="2" |
Decrease<br />1999[http://pubmed.gov/10588963 PMID] [http://dx.doi.org/10.1056/NEJM199912093412402 DOI]
| rowspan="2" valign="top" | 112 patients<br /><nowiki>* Vascular surgery: 100%</nowiki><br /><nowiki>* Abnl stress echo: 100%</nowiki>
| rowspan="2" valign="top" | Bisoprolol<br /><nowiki>* Started a median of 37 days preop</nowiki><br /><nowiki>* Target HR: > 50 bpm</nowiki>
| rowspan="2" | Open label
| rowspan="2" | Mortality at 30 days
| rowspan="2" bgcolor="lime" | 3.4
| rowspan="2" bgcolor="lime" | 17.0
| rowspan="2" colspan="2" | Not reported
| colspan="2" valign="top" | Discontinuation of study drug due to ADRs
|-
| 0%
| 0%
|-
| rowspan="2" |
Wallace/ MSPI<br />1996[http://content.nejm.org/cgi/content/full/335/23/1713 PMID]<br />[http://dx.doi.org/10.1056/NEJM199612053352301 DOI]
| rowspan="2" valign="top" | 200 patients<br /><nowiki>* Vascular: 41%</nowiki>
| rowspan="2" valign="top" | Atenolol<br /><nowiki>* Target HR: > 55 bpm</nowiki>
| rowspan="2" | Placebo
| rowspan="2" |
| rowspan="2" | 4%
| rowspan="2" | 2%
| rowspan="2" colspan="2" | Not reported
| colspan="2" | Discontinuation of study drug due to ADRs
|-
| 0%
| 0%
|}
|}


==References==
==References==
<references/>
<references/>

Revision as of 13:02, 8 July 2009

Randomized controlled trials with at least 100 total patients and at least one death.[1][2][3][4]
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
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
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
1999PMID DOI

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
1996PMID
DOI

200 patients
* Vascular: 41% 		Atenolol
* Target HR: > 55 bpm 		Placebo 4% 2% Not reported Discontinuation of study drug due to ADRs
0% 0%

References

  1. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
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