POISE: More Deaths, Strokes, Fewer MIs with Perioperative Beta Blocker at One Year

Perioperative treatment with a beta blocker resulted in significantly more deaths and strokes and fewer myocardial infarctions (MI) over 12 months, according to results of the multicenter, international POISE trial presented by P.J. Devereaux, MD, PhD, on Monday, March 12 in a Late-Breaking Clinical Trial session at ACC.18 in Orlando, FL.

The researchers hypothesized that perioperative beta blockade would decrease the risk of perioperative MI and its sequelae. The 30-day results showed that perioperative extended-release metoprolol reduced the risk of MI but increased the risk of stroke and mortality. To better understand the longer-term impact of perioperative beta blockade, secondary outcomes were evaluated one year after surgery.

A total of 8,351 patients at risk for or with a history of atherosclerosis undergoing noncardiac surgery were randomized to metoprolol or placebo. The metoprolol group received 100 mg two to four hours before surgery and at six hours after surgery. Beginning the day after surgery, the patients received 200 mg metoprolol daily for 30 days, with dose reduction to 100 mg in cases of hypotension or bradycardia.

At 12 months of follow-up, significantly fewer metoprolol patients vs. placebo patients had an MI (5 vs. 6.2 percent). At 12 months, all-cause mortality was significantly higher in the metoprolol group vs. the placebo group (9.8 vs. 8.5 percent), as was non-cardiovascular mortality (6 vs. 5 percent). No significant difference in cardiovascular mortality was observed.

At 12 months, significantly more patients in the metoprolol vs. placebo group had a stroke (2.0 vs. 1.4 percent). There were no significant differences in the incidence of cardiac arrest or pulmonary embolism.

“While there is little doubt that some patients benefit from receiving beta blockers during the period immediately before and after noncardiac surgery, these data show that at least as many patients are seriously harmed,” said Devereaux. “Hypotension is common in this setting and is a main mechanism regarding how adverse effects result from perioperative beta blockers,” he said. Devereaux concluded that further research is needed to establish a way to benefit from beta blockade while mitigating risk.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Cardiac Surgery and SIHD, Chronic Angina

Keywords: ACC18, ACC Annual Scientific Session, Angina, Stable, Metoprolol, Risk, Confidence Intervals, Myocardial Infarction, Myocardial Revascularization, Stroke, Drug Evaluation

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