Table 3

Characteristics of the 11 included randomised controlled trials

Study (intervention/control)DateMethodsParticipantsType of surgeriesInterventionsFollow-up
Mangano (99/101)1996Randomised double-blind placebo-controlled trialInclusion: previous myocardial infarction (MI), typical angina or atypical angina with a positive stress test, or at risk of coronary artery disease (CAD) as indicated by two of: age >65, hypertension, current smoking, cholesterol concentration >6.2 mmol/L and diabetesMajor vascular, intra-abdominal, orthopaedic, neurosurgical or other surgery5–10 mg intravenous (IV) or 50–100 mg oral atenolol 30 min pre surgery and continued until discharge, or a maximum of 7 days post surgery6-month, 1-year and 2-year outcomes
Bayliff (49/50)1999Randomised double-blind placebo-controlled trialInclusion: age >18. Exclusion: asthma, congestive heart failure (CHF), second or third degree heart block, history of supraventricular tacchyarrythmias, on a β-blocker, diltiazem, digoxin, quinidine, procainamide, amiodarone, verapamil, or sensitivity to β-blockersLobectomies, pneumonectomies, oesophagectomies.Propanolol 10 mg four times 1 day pre surgery, and continued for 5 days post surgeryOutcomes at hospital discharge
DECREASE I (59/53)1999Randomised controlled studyInclusion: at least one cardiac risk factor (age >70 years, prior MI, CHF, ventricular arrhythmia, diabetes, limited exercise capacity), who had a positive dobutamine echocardiogram (DSE). Exclusion: already on β-blockers, extensive wall motion abnormalities, asthmaElective vascular surgery5–10 mg oral bisoprolol from an average of 37 (at least 7) days pre surgery and continued for 30 days post surgery30-day outcomes
POBBLE (55/48)2005Randomised double-blind placebo-controlled trialInclusion: all patients not excluded.
Exclusion: already taking or intolerant to β-blockers, asthma, aortic stenosis, bradycardia, hypotension, previous MI in the past 2 years, unstable angina or angina with a positive DSE
Vascular surgeryOral or intravenous metoprolol day before surgery, then 25–50 mg oral metoprolol twice a day until 7 days after surgery30-day outcomes
DIPOM (462/459)2006Randomised double-blind placebo-controlled trialInclusion: age >39 years, with diabetes. Exclusion: on or allergic to β-blockers, NYHA class IV, third degree atrioventricular block, pregnant, breast feeding or in previous DIPOM trialOrthopedic, intra-abdominal, neurological, vascular, gynaecological or other surgery50–100 mg oral metoprolol 1 day before surgery and continued until hospital discharge, or a maximum of 8 days post surgeryMedian follow-up of 18 months (range 6–30 months)
MaVS (246/250)2006Randomised double-blind placebo-controlled trialInclusion: ASA class ≤3. Exclusion: current or recent β-blocker use, amiodarone, airflow obstruction requiring treatment, history of CHF or atrioventricular (AV) block, previous adverse reaction, previous participation in MaVS studyVascular surgery25–100 mg oral metoprolol within 2 h pre surgery, then oral or IV metoprolol until hospital discharge or 5 days post surgery30-day and 6-month outcomes
Neary (18/20)2006Randomised placebo-controlled trialInclusion: one of previous MI or ischaemia on ECG, history of angina, history of stroke or transient ischaemic attack; or two of age >65 years, hypertension, current smoking, cholesterol > 6.2 mmol/L, diabetes. Exclusion: already on or intolerant to β-blockers, bradycardia, COPD or asthma, second or third degree heart block, cardiovascular collapse or hypovolaemia, anaesthetist feels patient not fit for β-blockersEmergency general or orthopaedic surgery1.25 mg IV atenolol in the anaesthetic room, then every 30 min during surgery, then oral or IV atenolol daily for 7 days post surgeryMortality to hospital discharge and at 1 year
BBSA (110/109)2007Randomised double-blind placebo-controlled trialInclusion: CAD indicated by previous MI, angina, atypical angina with a positive stress test or previous coronary procedure or the presence of at least two of: hypertension, diabetes, hypercholesterolaemia, age >65 years and active smoking, Exclusion: chronic β-blockade, CHF, high degree AV block active asthma, left bundle branch blockOrthopaedic, urological, abdominal, gynaecological, plastic or vascular surgery5–10 mg oral bisoprolol 3 h before surgery and continued until hospital discharge or a maximum of 10 days post surgery30-day and 1-year outcomes
POISE (4174/4177)2008Randomised double-blind placebo-controlled trialInclusion: age >45 years, with a history of CAD, peripheral vascular disease, stroke, hospitalisation for CHF within the last 3 years, or with 3 of the following: intrathoracic or intraperitoneal surgery, CHF, transient ischaemic attack, creatinine >175 μmol/L, >70 years old, diabetes or undergoing emergent or urgent surgeryVascular, intraperitoneal, orthopaedic surgery100 mg oral extended-release metoprolol 2–4 h pre surgery and then 200 mg once a day for 30 days post surgery30-day outcomes
Yang (51/51)2008Randomised double-blind placebo-controlled trialInclusion: age >45 years and a history of CAD or peripheral vascular disease, stroke or hospitalisation for CHF in the last 3 years or any three of the following: high-risk surgery, CHF, diabetes, age >65 years, hypertensive, smoker or high cholesterol. Exclusion: heart rate <50, pacemaker, high degree AV block, active recent asthma, bronchospasm, COPD, adverse reaction to β-blockers, low-risk surgery, taking verapamil, liver or kidney dysfunction, emergency surgeryIntrathoracic or intra-abdominal surgeryOral or IV metoprolol from 2 h before surgery to 30 days after surgery30-day outcomes
DECREASE IV (533/533)2009Randomised open-label placebo-controlled trialInclusion: age >40 years with an estimated risk of perioperative cardiovascular event of 1–6% Exclusion: already on or contraindication to a β-blocker or statin, previous participation in the trial, inability to consent, emergency surgeryGeneral, urological, orthopaedic, ear nose and throat, gynaecological, plastic or other surgery2.5–10 mg oral bisoprolol started a median of 34 days pre surgery and continued for 30 days post surgery30-day outcomes
  • ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease.