Preoperative care/Catalogs/Beta-blocker evidence table: Difference between revisions
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imported>Robert Badgett No edit summary |
imported>Robert Badgett No edit summary |
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Decrease IV<ref name="pmid19474688"/><br />2009<br/>Drug provided by Merck KGaA | Decrease IV<ref name="pmid19474688"/><br />2009<br/>Drug provided by Merck KGaA | ||
| rowspan="2" valign="top" | 1066 patients<br /> • < 1% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] | | rowspan="2" valign="top" | 1066 patients:<br /> • < 1% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] = 2: 100% | ||
| rowspan="2" | [[Bisoprolol]]<br / | | rowspan="2" | [[Bisoprolol]]<br />• Started a median of 34 days preop<br />• Minimum allowed [[Heart rate|HR]]<sup>*</sup>: >50 bpm | ||
| rowspan="2" | Open label | | rowspan="2" | Open label | ||
| rowspan="2" | Mortality at 30 days | | rowspan="2" | Mortality at 30 days | ||
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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 /> • 42% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] | | rowspan="4" valign="top" | 8351 patients:<br /> • 42% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] = 2: uncertain | ||
| rowspan="4" valign="top"| [[Metoprolol]] succinate<br / | | rowspan="4" valign="top"| [[Metoprolol]] succinate<br />• Started day of surgery<br />• Minimum allowed [[Heart rate|HR]]<sup>*</sup>: > 50 bpm | ||
| rowspan="4" | Placebo | | rowspan="4" | Placebo | ||
| rowspan="4" | Mortality at two weeks | | rowspan="4" | Mortality at two weeks | ||
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|- | |- | ||
| rowspan="2" |BBSA<ref name="pmid17585213"/><br /> 2007<br/>Partially funded by industry<!--Roche, AstraZeneca Switzerland, Merck Switzerland-->. | | rowspan="2" |BBSA<ref name="pmid17585213"/><br /> 2007<br/>Partially funded by industry<!--Roche, AstraZeneca Switzerland, Merck Switzerland-->. | ||
| rowspan="2" valign="top" | 224 patients<br />• 1% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] | | rowspan="2" valign="top" | 224 patients:<br />• 1% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] = 2: uncertain | ||
| rowspan="2" valign="top" | [[Bisoprolol]]<br / | | 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" | Mortality at ''one year'' | | rowspan="2" | Mortality at ''one year'' | ||
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|- | |- | ||
| 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 | ||
| rowspan="2" valign="top" | 921 patients<br />• 7% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/>• All had diabetes | | rowspan="2" valign="top" | 921 patients:<br />• 7% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/>• All had diabetes | ||
| rowspan="2" valign="top" | [[Metoprolol]] succinate<br / | | 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" | Mortality at a median of ''18 months'' | | rowspan="2" | Mortality at a median of ''18 months'' | ||
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|- | |- | ||
| rowspan="2" |MaVS<ref name="pmid17070177"/><br />2006<br/>No industry funding. | | 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]] | | 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 HR: > 50 bpm while awake;<br />>45 bpm while asleep. | | 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" | Placebo | ||
| rowspan="2" | Hospital mortality | | rowspan="2" | Hospital mortality | ||
| Line 96: | Line 96: | ||
|- | |- | ||
| rowspan="2" | POBBLE<ref name="pmid15874923"/><br />2005<br/>No industry funding. | | rowspan="2" | POBBLE<ref name="pmid15874923"/><br />2005<br/>No industry funding. | ||
| rowspan="2" valign="top" | 103 patients<br />• 100% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/> | | rowspan="2" valign="top" | 103 patients:<br />• 100% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/> | ||
| rowspan="2" valign="top" | [[Metoprolol]]<br / | | rowspan="2" valign="top" | [[Metoprolol]]<br />• Start with test dose one day preop<br />• Minimum allowed [[Heart rate|HR]]<sup>*</sup>: > 50 bpm | ||
| rowspan="2" | Placebo (anesthesiologists were not blinded) | | rowspan="2" | Placebo (anesthesiologists were not blinded) | ||
| rowspan="2" | Mortality at 30 days | | rowspan="2" | Mortality at 30 days | ||
| Line 110: | Line 110: | ||
|- | |- | ||
| rowspan="2" |Decrease<ref name="pmid10588963"/><br />1999<br/>Uncertain funding. | | rowspan="2" |Decrease<ref name="pmid10588963"/><br />1999<br/>Uncertain funding. | ||
| rowspan="2" valign="top" | 112 patients<br />• 100% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] | | rowspan="2" valign="top" | 112 patients:<br />• 100% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] = 2: uncertain, at least 67%<br/>• Abnl stress echo: 100% | ||
| rowspan="2" valign="top" | [[Bisoprolol]]<br / | | rowspan="2" valign="top" | [[Bisoprolol]]<br />• Started a median of 37 days preop<br />• Minimum allowed [[Heart rate|HR]]<sup>*</sup>: > 50 bpm | ||
| rowspan="2" | Open label | | rowspan="2" | Open label | ||
| rowspan="2" | Mortality at 30 days | | rowspan="2" | Mortality at 30 days | ||
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|- | |- | ||
| rowspan="2" |Mangano/ MSPI<ref name="pmid8929262"/><br />1996<br/>No industry funding. | | rowspan="2" |Mangano/ MSPI<ref name="pmid8929262"/><br />1996<br/>No industry funding. | ||
| rowspan="2" valign="top" | 200 patients<br />• 41% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/> | | rowspan="2" valign="top" | 200 patients:<br />• 41% vascular surgery<br />• [[Revised Cardiac Risk Index|RCRI]] > 2: uncertain<br/> | ||
| rowspan="2" valign="top" | [[Atenolol]]<br / | | rowspan="2" valign="top" | [[Atenolol]]<br />• Minimum allowed [[Heart rate|HR]]<sup>*</sup>: > 55 bpm | ||
| rowspan="2" | Placebo | | rowspan="2" | Placebo | ||
| rowspan="2" | Hospital mortality | | rowspan="2" | Hospital mortality | ||
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| align="center" |13% | | align="center" |13% | ||
|- | |- | ||
|colspan="11"|Notes: | |colspan="11"| | ||
<nowiki>* </nowiki> Minimum allowed [[Heart rate|HR]]. The lowest heart rate allowed before [[Adrenergic beta-antagonist|beta-blockers]] were withheld.<br/> | |||
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. | # 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"/> | # 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"/> | # Mavs had trend toward most benefit in [[Revised Cardiac Risk Index|RCRI]] = 3.<ref name="pmid17070177"/> | ||
|} | |} | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 12:06, 26 August 2009
| Patients | Intervention | Comparison | Outcome | Results | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mortality | Stroke | Beta-blocker toxicity | ||||||||
| Rx | Control | Rx | Control | Rx | Control | |||||
|
Decrease IV[1] |
1066 patients: • < 1% 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 | Mortality at one year | 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 | Mortality at a median of 18 months | 16% | 16% | 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% | Not reported | 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[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 | 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%[9] | 1%[9] | Intraoperative inotropes given[9] | |
| 13% | 13% | |||||||||
|
* Minimum allowed HR. The lowest heart rate allowed before beta-blockers were withheld.
| ||||||||||
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 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]