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Therapeutics
Metoprolol prevented myocardial infarction but increased risk of stroke and death after non-cardiac surgery

https://doi.org/10.1136/ebm.13.6.175

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    P J Devereaux

    Dr P J Devereaux, McMaster University, Hamilton, Ontario, Canada; phillipj@mcmaster.ca

    STUDY DESIGN

    Design:

    randomised placebo-controlled trial (PeriOperative ISchemic Evaluation [POISE]).

    Allocation concealment:

    concealed.*

    Blinding:

    blinded (patients, clinicians, data collectors, and outcome adjudicators).*

    STUDY QUESTION

    Setting:

    190 hospitals in 23 countries worldwide.

    Patients:

    8351 patients ⩾45 years of age (mean age 69 y, 63% men) who were having non-cardiac surgery with an expected hospital stay ⩾24 hours and fulfilled specific criteria indicating that they had, or were at risk of, atherosclerotic disease.

    Intervention:

    oral extended-release metoprolol succinate (n = 4174) or placebo (n = 4177), 100 mg 2–4 hours before surgery and 6 hours after surgery (or earlier if heart rate was ⩾80 bpm and systolic blood pressure was ⩾100 mm Hg), then 200 mg daily for …

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