Preoperative care/Catalogs/Beta-blocker evidence table

Randomized controlled trials with at least 100 total patients and at least one death.
(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 2009 Drug provided by Merck KGaA	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 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 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 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 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 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 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 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: Color indicates statistically significant differences with green indicating benefit and red indicating harm. BBSA noted more drug toxicity among patients with abnormal beta1-adrenergic receptor genetic polymorphisms. Mavs had trend toward most benefit in RCRI = 3.