TY - JOUR
T1 - How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials
AU - Devereaux, P. J.
AU - Beattie, W. Scott
AU - Choi, Peter T.L.
AU - Badner, Neal H.
AU - Guyatt, Gordon H.
AU - Villar, Juan C.
AU - Cinà, Claudio S.
AU - Leslie, Kate
AU - Jacka, Michael J.
AU - Montori, Victor M.
AU - Bhandari, Mohit
AU - Avezum, Alvaro
AU - Cavalcanti, Alexandre B.
AU - Giles, Julian W.
AU - Schricker, Thomas
AU - Yang, Homer
AU - Jakobsen, Carl Johan
AU - Yusuf, Salim
PY - 2005/8/6
Y1 - 2005/8/6
N2 - Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.
AB - Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.
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U2 - 10.1136/bmj.38503.623646.8F
DO - 10.1136/bmj.38503.623646.8F
M3 - Review article
C2 - 15996966
AN - SCOPUS:23444449308
SN - 0959-8146
VL - 331
SP - 313
EP - 316
JO - British medical journal
JF - British medical journal
IS - 7512
ER -