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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| rowspan="2" | Open label | | rowspan="2" | Open label | ||
| rowspan="2" | Mortality at 30 days | | rowspan="2" | Mortality at 30 days | ||
| rowspan="2" align="center" bgcolor="lime" | 3.4 | | rowspan="2" align="center" bgcolor="lime" | 3.4%<br/>(8.5%<sup>†</sup>) | ||
| rowspan="2" align="center" bgcolor="lime" | 17.0 | | rowspan="2" align="center" bgcolor="lime" | 17.0% | ||
| rowspan="2" colspan="2" | Not reported | | rowspan="2" colspan="2" | Not reported | ||
| colspan="2" valign="top" | Discontinuation of study drug due to [[Adverse drug reaction|ADR]]s: | | colspan="2" valign="top" | Discontinuation of study drug due to [[Adverse drug reaction|ADR]]s: | ||
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|colspan="11"| | |colspan="11"| | ||
<nowiki>* </nowiki> Minimum allowed [[Heart rate|HR]]. The lowest heart rate allowed before [[Adrenergic beta-antagonist|beta-blockers]] were withheld.<br/> | <nowiki>* </nowiki> Minimum allowed [[Heart rate|HR]]. The lowest heart rate allowed before [[Adrenergic beta-antagonist|beta-blockers]] were withheld.<br/> | ||
↑ The DECREASE 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/> | |||
Notes: | 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. | ||
Revision as of 15:57, 30 August 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% • RCRI = 2: ~100% • < 1% vascular surgery |
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% | 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[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%[10] | 1%[10] | Intraoperative inotropes given:[10] | |
| 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]
- ↑ 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
- ↑ 10.0 10.1 10.2 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]