Preoperative care/Catalogs/Beta-blocker evidence table: Difference between revisions
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|+ [[ | |+ Selected<sup>*</sup> [[randomized controlled trial]]s of perioperative<sup>'''†'''</sup> [[Adrenergic beta-antagonist|beta-blockers]].<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="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="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="pmid16764198">{{cite journal| author=Neary WD, McCrirrick A, Foy C, Heather BP, Earnshaw JJ| title=Lessons learned from a randomised controlled study of perioperative beta blockade in high risk patients undergoing emergency surgery. | journal=Surgeon | year= 2006 | volume= 4 | issue= 3 | pages= 139-43 | pmid=16764198 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16764198 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></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><ref name="pmid19012955">{{cite journal| author=Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH| title=Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. | journal=Lancet | year= 2008 | volume= 372 | issue= 9654 | pages= 1962-76 | pmid=19012955 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19012955 | doi=10.1016/S0140-6736(08)61560-3 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19306485 Review in: Ann Intern Med. 2009 Mar 17;150(6):JC3-4] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><br/>(See legend and notes at bottom on the table) | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19012955 | doi=10.1016/S0140-6736(08)61560-3 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19306485 Review in: Ann Intern Med. 2009 Mar 17;150(6):JC3-4] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><br/>(See legend and notes at bottom on the table) | ||
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| align="center" | 0% | | align="center" | 0% | ||
| align="center" | 2.7% | | align="center" | 2.7% | ||
|- | |||
| rowspan="2" |MaVS<ref name="pmid17070177"/><br />2006<br/>No industry funding. | |||
| rowspan="2" valign="top" | 496 patients:<br />• 100% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] = 2: 40%<br/> | |||
| rowspan="2" valign="top" | [[Metoprolol]]<br />• Start: day of surgery<br />• Minimum allowed [[Heart rate|HR]]<sup>‡</sup>: > 50 bpm while awake;<br />>45 bpm while asleep. | |||
| rowspan="2" | Placebo | |||
| rowspan="2" | Hospital mortality | |||
| rowspan="2" align="center" | 0.4% | |||
| rowspan="2" align="center" | 2.8% | |||
| rowspan="2" align="center" | 2.0% <!--From their Table V --> | |||
| rowspan="2" align="center" | 1.6% <!--From their Table V --> | |||
| colspan="2" | Intraoperative hypotension treated: | |||
|- | |||
| bgcolor="red" align="center" | 46% | |||
| bgcolor="red" align="center" | 34% | |||
|- | |- | ||
| rowspan="2" |DIPOM<ref name="pmid16793810"/><br /> 2006<br />Partially funded by AstraZeneca | | rowspan="2" |DIPOM<ref name="pmid16793810"/><br /> 2006<br />Partially funded by AstraZeneca | ||
| Line 83: | Line 98: | ||
| align="center" | 0.2% | | align="center" | 0.2% | ||
|- | |- | ||
| rowspan="2" | | | rowspan="2" |Neary<ref name="pmid16764198"/><br /> 2006<br />Funded by the Gloucester Vascular Research Trust fund. | ||
| rowspan="2" valign="top" | | | rowspan="2" valign="top" | 38 patients:<br />• 21% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/> | ||
| rowspan="2" valign="top" | [[ | | rowspan="2" valign="top" | [[Atenolol]]<br />• Started at induction<br />• Minimum allowed [[Heart rate|HR]]<sup>‡</sup>: uncertain | ||
| rowspan="2" | Placebo | | rowspan="2" | Placebo | ||
| rowspan="2" | Hospital mortality | | rowspan="2" | Hospital mortality | ||
| rowspan="2" align="center" | | | rowspan="2" align="center" | 17% | ||
| rowspan="2" align="center" | | | rowspan="2" align="center" | 25% | ||
| rowspan="2" align="center" | | | rowspan="2" align="center" | Unknown | ||
| rowspan="2" align="center" | | | rowspan="2" align="center" | Unknown | ||
| colspan="2" | | | colspan="2" | Hypotension reported as an [[Adverse drug reaction|ADR]]: | ||
|- | |- | ||
| | | align="center" | 5.5%<br/>(one pt) | ||
| | | align="center" | 5.0%<br/>(one pt) | ||
|- | |- | ||
| rowspan="2" | POBBLE<ref name="pmid15874923"/><br />2005<br/>No industry funding. | | rowspan="2" | POBBLE<ref name="pmid15874923"/><br />2005<br/>No industry funding. | ||
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|- | |- | ||
|colspan="11"| | |colspan="11"| | ||
<nowiki>*</nowiki> This table does not include trials that used [[Adrenergic beta-antagonist|beta-blockers]] only for [[premedication]] or only during [[postoperative care | <nowiki>*</nowiki> Trials were selected by. Excluded trials are listed below.<br/> | ||
<nowiki>†</nowiki> This table does not include trials that used [[Adrenergic beta-antagonist|beta-blockers]] only for [[premedication]] or only during [[postoperative care]].<br/> | |||
‡ Minimum allowed [[Heart rate|HR]]. The lowest heart rate allowed before [[Adrenergic beta-antagonist|beta-blockers]] were withheld.<br/> | ‡ Minimum allowed [[Heart rate|HR]]. The lowest heart rate allowed before [[Adrenergic beta-antagonist|beta-blockers]] were withheld.<br/> | ||
§ The DECREASE I trial was stopped early when a significant benefit was observed and the [[relative risk]] was 0.2. By [http://medinformatics.uthscsa.edu/calculator/calc_bayes_r-example.shtml Bayesian analysis], the relative risk is more likely to be 0.5 which leads to an event rate in the treatment group of 8.5%.<br/> | § The DECREASE I trial was stopped early when a significant benefit was observed and the [[relative risk]] was 0.2. By [http://medinformatics.uthscsa.edu/calculator/calc_bayes_r-example.shtml Bayesian analysis], the relative risk is more likely to be 0.5 which leads to an event rate in the treatment group of 8.5%.<br/> | ||
| Line 163: | Line 178: | ||
* {{cite journal| author=Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P| title=Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. | journal=Anesth Analg | year= 2000 | volume= 90 | issue= 6 | pages= 1257-61 | pmid=10825304 | * {{cite journal| author=Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P| title=Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. | journal=Anesth Analg | year= 2000 | volume= 90 | issue= 6 | pages= 1257-61 | pmid=10825304 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10825304 }} | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10825304 }} | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 11:16, 21 October 2009
| Patients | Intervention | Comparison | Outcome | Results | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mortality | Stroke | Beta-blocker toxicity | ||||||||
| Rx | Control | Rx | Control | Rx | Control | |||||
| 1066 patients: •estimated risk of perioperative cardiovascular death of ≥ 1% • 0% vascular surgery • RCRI = 2: ~100% |
Bisoprolol • Started a median of 34 days preop • Minimum allowed 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 succinate • Started day of surgery • Minimum allowed 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 Partially funded by industry. |
224 patients: • 1% vascular surgery • RCRI = 2: uncertain |
Bisoprolol • Started day of surgery Minimum allowed HR‡: > 50bpm |
Placebo | Hospital mortality | 0.9% | 0.9% | 1.8% | 0% | Hypotension: | |
| 0% | 2.7% | |||||||||
| MaVS[4] 2006 No industry funding. |
496 patients: • 100% vascular surgery • RCRI = 2: 40% |
Metoprolol • Start: day of surgery • Minimum allowed HR‡: > 50 bpm while awake; >45 bpm while asleep. |
Placebo | Hospital mortality | 0.4% | 2.8% | 2.0% | 1.6% | Intraoperative hypotension treated: | |
| 46% | 34% | |||||||||
| DIPOM[5] 2006 Partially funded by AstraZeneca |
921 patients: • 7% vascular surgery • RCRI > 2: uncertain • All had diabetes |
Metoprolol succinate • Started 0-1 days preop • Minimum allowed HR‡: >55 bpm |
Placebo | Hospital mortality | 4%[10] | 3%[10] | 0.4% | 0% | Hypotension reported as an ADR: | |
| 0.4% | 0.2% | |||||||||
| Neary[6] 2006 Funded by the Gloucester Vascular Research Trust fund. |
38 patients: • 21% vascular surgery • RCRI > 2: uncertain |
Atenolol • Started at induction • Minimum allowed HR‡: uncertain |
Placebo | Hospital mortality | 17% | 25% | Unknown | Unknown | Hypotension reported as an ADR: | |
| 5.5% (one pt) |
5.0% (one pt) | |||||||||
| POBBLE[7] 2005 No industry funding. |
103 patients: • 100% vascular surgery • RCRI > 2: uncertain |
Metoprolol • Start with test dose one day preop • Minimum allowed HR‡: > 50 bpm |
Placebo (anesthesiologists were not blinded) | Mortality at 30 days | 3% | 1% | 2% | 0% | Intraoperative inotropes given: | |
| 92% | 64% | |||||||||
| Decrease I[8] 1999 Uncertain funding. |
112 patients: • 100% vascular surgery • RCRI = 2: uncertain, at least 67% • Abnl stress echo: 100% |
Bisoprolol • Started a median of 37 days preop • Minimum allowed HR‡: > 50 bpm |
Open label | Mortality at 30 days | 3.4% (8.5%§) |
17.0% | Not reported | Discontinuation of study drug due to ADRs: | ||
| 0% | 0% | |||||||||
| Mangano/ MSPI[9] 1996 No industry funding. |
200 patients: • 41% vascular surgery • RCRI > 2: uncertain |
Atenolol • Started IV on the day of surgery • Minimum allowed HR‡: > 55 bpm |
Placebo | Hospital mortality | 4% | 2% | 4%[12] | 1%[12] | Intraoperative inotropes given:[12] | |
| 13% | 13% | |||||||||
|
* Trials were selected by. Excluded trials are listed below.
| ||||||||||
Excluded trials
The following randomized controlled trials of beta-blockers were excluded because beta-blockers were only given as premedication or only give during postoperative care. Trials that only used beta-blockers only for premedication:
- Miller DR, Martineau RJ, Wynands JE, Hill J (1991). "Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial.". Can J Anaesth 38 (7): 849-58. PMID 1683818.
- Jakobsen CJ, Blom L, Brondbjerg M, Lenler-Petersen P (1990). "Effect of metoprolol and diazepam on pre-operative anxiety.". Anaesthesia 45 (1): 40-3. PMID 2316838.
- Stone JG, Foëx P, Sear JW, Johnson LL, Khambatta HJ, Triner L (1988). "Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients.". Br J Anaesth 61 (6): 675-9. PMID 3207540.
Trials that only used beta-blockers only during postoperative care:
- Raby KE, Brull SJ, Timimi F, Akhtar S, Rosenbaum S, Naimi C et al. (1999). "The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery.". Anesth Analg 88 (3): 477-82. PMID 10071990.
- Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P (2000). "Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia.". Anesth Analg 90 (6): 1257-61. PMID 10825304.
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 4.2 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.
- ↑ 5.0 5.1 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.
- ↑ 6.0 6.1 Neary WD, McCrirrick A, Foy C, Heather BP, Earnshaw JJ (2006). "Lessons learned from a randomised controlled study of perioperative beta blockade in high risk patients undergoing emergency surgery.". Surgeon 4 (3): 139-43. PMID 16764198.
- ↑ 7.0 7.1 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.
- ↑ 8.0 8.1 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]
- ↑ 9.0 9.1 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]
- ↑ 10.0 10.1 10.2 Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH (2008). "Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis.". Lancet 372 (9654): 1962-76. DOI:10.1016/S0140-6736(08)61560-3. PMID 19012955. Research Blogging. Review in: Ann Intern Med. 2009 Mar 17;150(6):JC3-4
- ↑ Schouten O et al. Fluvastatin and bisoprolol for the reduction of perioperative cardiac mortality and morbidity in high-risk patients undergoing non-cardiac surgery: rationale and design of the DECREASE-IV study. Am Heart J. 2004 Dec;148(6):1047-52. DOI:10.1016/j.ahj.2004.05.046 PMID 15632892
- ↑ 12.0 12.1 12.2 Wallace A, Layug B, Tateo I, et al. (January 1998). "Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group". Anesthesiology 88 (1): 7–17. PMID 9447850. [e]