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

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imported>Robert Badgett
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imported>Robert Badgett
(Reworded vascular surgery column)
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| rowspan="2" |
| rowspan="2" |
Decrease IV<ref name="pmid19474688"/><br />2009
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" valign="top" | 1066 patients<br /> * &lt; 1% vascular surgery<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" | [[Bisoprolol]]<br /><nowiki>* Started a median of 34 days preop</nowiki><br /><nowiki>* Target HR: >50 bpm</nowiki>
| rowspan="2" | Open label
| rowspan="2" | Open label
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|-
|-
| rowspan="4" |POISE<ref name="pmid18479744"/><br/>2008<br />Partially funded by AstraZeneca
| rowspan="4" |POISE<ref name="pmid18479744"/><br/>2008<br />Partially funded by AstraZeneca
| rowspan="4" valign="top" | 8351 patients<br /> * Vascular: 42%<br /><nowiki>*</nowiki> [[Revised Cardiac Risk Index|RCRI]] ≥ 2: uncertain
| rowspan="4" valign="top" | 8351 patients<br /> * 42% vascular surgery<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" valign="top"| [[Metoprolol]]<br /><nowiki>* Started day of surgery</nowiki><br /><nowiki>* Target HR: &gt; 50 bpm</nowiki>
| rowspan="4" | Placebo
| rowspan="4" | Placebo
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|-
|-
| rowspan="2" |BBSA<ref name="pmid17585213"/><br /> 2007
| 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" | 224 patients<br /><nowiki>*</nowiki> 1% vascular surgery<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" valign="top" | [[Bisoprolol]]<br /><nowiki>* Started day of surgery</nowiki><br />Target HR: > 50bpm
| rowspan="2" | Placebo
| rowspan="2" | Placebo
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|-
|-
| rowspan="2" |DIPOM<ref name="pmid16793810"/><br /> 2006
| 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" | 921 patients<br /><nowiki>*</nowiki> 7% vascular surgery<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" valign="top" | [[Metoprolol]]<br /><nowiki>* Started 0-1 days preop</nowiki><br /><nowiki>* Target HR: >55 bpm</nowiki>
| rowspan="2" | Placebo
| rowspan="2" | Placebo
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|-
|-
| rowspan="2" |MaVS<ref name="pmid17070177"/><br />2006
| 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" | 496 patients<br /><nowiki>*</nowiki> 100% vascular surgery<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" 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" | Placebo
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|-
|-
| rowspan="2" | POBBLE<ref name="pmid15874923"/><br />2005
| 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" | 103 patients<br /><nowiki>*</nowiki> 100% vascular surgery<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" 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" | Placebo (anesthesiologists were not blinded)
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|-
|-
| rowspan="2" |Decrease<ref name="pmid10588963"/><br />1999
| 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" | 112 patients<br /><nowiki>*</nowiki> 100% vascular surgery<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" 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" | Open label
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|-
|-
| rowspan="2" |Wallace/ MSPI<ref name="pmid8929262"/><br />1996
| 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" | 200 patients<br /><nowiki>*</nowiki> 41% vascular surgery<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" valign="top" | [[Atenolol]]<br /><nowiki>* Target HR: > 55 bpm</nowiki>
| rowspan="2" | Placebo
| rowspan="2" | Placebo

Revision as of 14:52, 14 July 2009

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
* < 1% vascular surgery
* 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
Partially funded by AstraZeneca 		8351 patients
* 42% vascular surgery
* 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 on composite events. Mortality by surgery type not reported.
BBSA[3]
2007 		224 patients
* 1% vascular surgery
* 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
* 7% vascular surgery
*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
* 100% vascular surgery
*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
* 100% vascular surgery
*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
* 100% vascular surgery
*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
* 41% vascular surgery
*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:
  1. Color indicates statistically significant differences with green indicating benefit and red indicating harm.
  2. BBSA noted more drug toxicity among patients with abnormal beta1-adrenergic receptor genetic polymorphisms.[3]
  3. Mavs had trend toward most benefit in RCRI = 3.[5]


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 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. ↑ 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. ↑ 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. ↑ 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. ↑ 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. ↑ 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]
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