Preoperative care/Catalogs/Beta-blocker evidence table: Difference between revisions
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|+ [[Randomized controlled trial]]s of perioperative<sup>'''*'''</sup> [[Adrenergic beta-antagonist|beta-blockers]] with at least 100<sup>†</sup> total patients.<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) | |+ [[Randomized controlled trial]]s of perioperative<sup>'''*'''</sup> [[Adrenergic beta-antagonist|beta-blockers]] with at least 100<sup>†</sup> total patients.<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><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) | |||
|- | |- | ||
! rowspan="3" | | ! rowspan="3" | | ||
| Line 58: | Line 59: | ||
| rowspan="2" valign="top" | [[Bisoprolol]]<br />• Started day of surgery<br />Minimum allowed [[Heart rate|HR]]<sup>‡</sup>: > 50bpm | | rowspan="2" valign="top" | [[Bisoprolol]]<br />• Started day of surgery<br />Minimum allowed [[Heart rate|HR]]<sup>‡</sup>: > 50bpm | ||
| rowspan="2" | Placebo | | rowspan="2" | Placebo | ||
| rowspan="2" | | | rowspan="2" | Hospital mortality | ||
| rowspan="2" align="center" | 0.9 | | rowspan="2" align="center" | 0.9% | ||
| rowspan="2" align="center" | 0.9 | | rowspan="2" align="center" | 0.9% | ||
| rowspan="2" align="center" | 1.8%<!-- Short term; from table 8 --> | | rowspan="2" align="center" | 1.8%<!-- Short term; from table 8 --> | ||
| rowspan="2" align="center" | 0%<!-- Short term; from table 8 --> | | rowspan="2" align="center" | 0%<!-- Short term; from table 8 --> | ||
| Line 72: | Line 73: | ||
| rowspan="2" valign="top" | [[Metoprolol]] succinate<br />• Started 0-1 days preop<br />• Minimum allowed [[Heart rate|HR]]<sup>‡</sup>: >55 bpm | | rowspan="2" valign="top" | [[Metoprolol]] succinate<br />• Started 0-1 days preop<br />• Minimum allowed [[Heart rate|HR]]<sup>‡</sup>: >55 bpm | ||
| rowspan="2" | Placebo | | rowspan="2" | Placebo | ||
| rowspan="2" | | | rowspan="2" | Hospital mortality | ||
| rowspan="2" align="center" | | | rowspan="2" align="center" | 4%<ref name="pmid19012955"/> | ||
| rowspan="2" align="center" | | | rowspan="2" align="center" | 3%<ref name="pmid19012955"/> | ||
| rowspan="2" align="center" | 0.4% | | rowspan="2" align="center" | 0.4% | ||
| rowspan="2" align="center" | 0% | | rowspan="2" align="center" | 0% | ||
Revision as of 11:22, 26 September 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% | |||||||||
| DIPOM[4] 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%[9] | 3%[9] | 0.4% | 0% | Hypotension reported as an ADR: | |
| 0.4% | 0.2% | |||||||||
| MaVS[5] 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% | 1.6% | 2.0% | 1.6% | Intraoperative hypotension treated: | |
| 46% | 34% | |||||||||
| POBBLE[6] 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[7] 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[8] 1996 No industry funding. |
200 patients: • 41% vascular surgery • RCRI > 2: uncertain |
Atenolol • Minimum allowed HR‡: > 55 bpm |
Placebo | Hospital mortality | 4% | 2% | 4%[11] | 1%[11] | Intraoperative inotropes given:[11] | |
| 13% | 13% | |||||||||
|
* This table does not include trials that used beta-blockers only for premedication or only during postoperative care.
| ||||||||||
Excluded trials
The following randomized controlled trials of beta-blockers had at least 100 total subjects but 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:
- 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 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.
- ↑ 5.0 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.
- ↑ 6.0 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.
- ↑ 7.0 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]
- ↑ 8.0 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]
- ↑ 9.0 9.1 9.2 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
- ↑ 11.0 11.1 11.2 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]