View source for Preoperative care/Catalogs/Beta-blocker evidence table

{| class="wikitable"
|+  [[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><ref name="pmid17070177">{{cite journal |author=Yang H, Raymer K, Butler R, Parlow J, Roberts R |title=The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial |journal=Am. Heart J. |volume=152 |issue=5 |pages=983–90 |year=2006 |month=November |pmid=17070177 |doi=10.1016/j.ahj.2006.07.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(06)00739-3 |issn=}}</ref><ref name="pmid15874923">{{cite journal |author=Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR |title=Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=602–9 |year=2005 |month=April |pmid=15874923 |doi=10.1016/j.jvs.2005.01.048 |url=http://linkinghub.elsevier.com/retrieve/pii/S0741521405001898 |issn=}}</ref><ref name="pmid10588963">{{cite journal |author=Poldermans D, Boersma E, Bax JJ, ''et al.'' |title=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 |journal=N. Engl. J. Med. |volume=341 |issue=24 |pages=1789–94 |year=1999 |month=December |pmid=10588963 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=10588963&promo=ONFLNS19 |issn=}}</ref><ref name="pmid8929262">{{cite journal |author=Mangano DT, Layug EL, Wallace A, Tateo I |title=Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group |journal=N. Engl. J. Med. |volume=335 |issue=23 |pages=1713–20 |year=1996 |month=December |pmid=8929262 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8929262&promo=ONFLNS19 |issn=}}</ref><br/>(See legend and notes at bottom on the table)
|-
! rowspan="3" |
! rowspan="3" | Patients
! rowspan="3" | Intervention
! rowspan="3" | Comparison
! rowspan="3" | Outcome
! colspan="6" align="center" | Results
|-
! colspan="2" | Mortality
! colspan="2" | Stroke
! colspan="2" | Beta-blocker toxicity
|-
! 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: &lt; 1%<br /><nowiki>*</nowiki> [[Revised Cardiac Risk Index|RCRI]] ≥ 2: 100%
| 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
|-
| 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>*</nowiki> [[Revised Cardiac Risk Index|RCRI]] ≥ 2: uncertain
| rowspan="4" valign="top"| [[Metoprolol]]<br /><nowiki>* Started day of surgery</nowiki><br /><nowiki>* Target HR: &gt; 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 on composite events. Mortality by surgery type not reported.
|-
| rowspan="2" |BBSA<ref name="pmid17585213"/><br /> 2007
| rowspan="2" valign="top" | 224 patients<br /><nowiki>*</nowiki> Vascular: 1%<br /><nowiki>*</nowiki> [[Revised Cardiac Risk Index|RCRI]] ≥ 2: uncertain
| 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>*</nowiki> Vascular: 7%<br /><nowiki>*</nowiki>[[Revised Cardiac Risk Index|RCRI]] &gt; 2: uncertain<br/><nowiki>*</nowiki> All had diabetes
| 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" |MaVS<ref name="pmid17070177"/><br />2006
| rowspan="2" valign="top" | 496 patients<br /><nowiki>*</nowiki> Vascular: 100%<br /><nowiki>*</nowiki>[[Revised Cardiac Risk Index|RCRI]] ≥ 2: 40%<br/>
| 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" | POBBLE<ref name="pmid15874923"/><br />2005
| rowspan="2" valign="top" | 103 patients<br /><nowiki>*</nowiki> Vascular: 100%<br /><nowiki>*</nowiki>[[Revised Cardiac Risk Index|RCRI]] &gt; 2: uncertain<br/>
| 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<ref name="pmid10588963"/><br />1999
| rowspan="2" valign="top" | 112 patients<br /><nowiki>*</nowiki> Vascular surgery: 100%<br /><nowiki>*</nowiki>[[Revised Cardiac Risk Index|RCRI]] ≥ 2: uncertain, at least 67%<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<ref name="pmid8929262"/><br />1996
| rowspan="2" valign="top" | 200 patients<br /><nowiki>*</nowiki> Vascular: 41%<br /><nowiki>*</nowiki>[[Revised Cardiac Risk Index|RCRI]] &gt; 2: uncertain<br/>
| rowspan="2" valign="top" | [[Atenolol]]<br /><nowiki>* Target HR: > 55 bpm</nowiki>
| rowspan="2" | Placebo
| rowspan="2" | Hospital mortality
| rowspan="2" | 4%
| rowspan="2" | 2%
| rowspan="2" colspan="2" | Not reported
| colspan="2" | Discontinuation of study drug due to ADRs
|-
| 0%
| 0%
|-
|colspan="11"|Notes:
# Color indicates statistically significant differences with <span style="font-weight:bold;color:lime">green</span> indicating benefit and <span style="font-weight:bold;color:red">red</span> indicating harm.
# BBSA noted more [[drug toxicity]] among patients with abnormal beta1-[[adrenergic receptor]] [[genetic polymorphism]]s.<ref name="pmid17585213"/>
# Mavs had trend toward most benefit in [[Revised Cardiac Risk Index|RCRI]] = 3.<ref name="pmid17070177"/>
|}



==References==
<references/>