POISE results and perioperative (beta)-blockade

摘要

RESULTS from the Perioperative Ischemic Evaluation Trial (POISE) have recently been published.1 Conducted in 190 hospitals in 23 different countries, with a total of 8,351 patients, it is the largest trial, by far, on the subject of perioperative (beta)-blockade. Also worthy of note is the fact that the trial was conducted by a multi-disciplinary team. The results from POISE show that the primary endpoint, defined as non-fatal myocardial infarction (MI), cardiac death, or non-fatal cardiac arrest, was reached in 5.8% and 6.9% of the metoprolol and placebo groups, respectively, hazard ratio (HR) 0.84 [95% confidence interval (CI) 0.70-0.99], P = 0.0399. The incidence of MI in the metoprolol group was 4.2% and the placebo group 5.7%, HR 0.73 (95% CI 0.60-0.89), P - 0.0017. In fact, the reduction in primary endpoint in the (beta)-blocker group is driven mainly by the reduction in the incidence of ML However, the stroke rate was 1.0% and 0.5% in the metoprolol and placebo groups, respectively, HR 2.17 (1.26-3.74), P = 0.0053. The overall mortality was 3.1% and 2.3% in the metoprolol and placebo groups, respectively, HR 1.33 (95% CI 1.03-1.74), P = 0.0317. The incidence of MI is reduced by (beta)-blockers, but at the cost of increasing the stroke rate and the overall mortality.