POISE
PeriOperative ISchemic Evaluation trial
Patient / Population Intervention / Exposition Vergleich Endpunkt
In 8,351 patients with or at risk of atherosclerotic disease undergoing non-cardiac surgery, extended-release metoprolol started hours before surgery reduced cardiovascular death, non-fatal myocardial infarction or non-fatal cardiac arrest at 30 days but increased death and stroke compared with placebo.
N
8.351
Design
Double-blind, placebo-controlled RCT
Endpunkt
Composite of cardiovascular death, non-fatal MI or non-fatal cardiac arrest at 30 days
Relevanz
1
Ergebnis5.8 % vs 6.9 % (HR 0.84; 95 % CI 0.70–0.99; p=0.04), but all-cause death 3.1 % vs 2.3 % (HR 1.33; p=0.03) and stroke 1.0 % vs 0.5 % (HR 2.17; p=0.005).
POISE Study Group; Devereaux PJ, Yang H, et al. Lancet. 2008;371(9627):1839-1847. 10.1016/S0140-6736(08)60601-7
Diskussion & Kritik
A fixed high dose given without titration hours before surgery, so the excess hypotension, stroke and death may reflect the dosing strategy rather than beta-blockade itself. It is the largest perioperative beta-blocker trial and directly drives the recommendation against starting high-dose beta-blockers immediately before surgery.