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

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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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