Trial reportLancet (London, England)2008
Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial.
Trial report in Lancet (London, England), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 7 registered trials, which are not on this map. Cited by 433 papers, 16 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Multicenter Randomized Controlled Trial of Loading Dose Statins for the Prevention of Cardiovascular Complications in High-Risk Non-Cardiac Surgery
Open the trial in the graphPerioperative Ischemic Evaluation Study (POISE) Trial
The PACE-MI Registry Study - Outcomes of Beta-blocker Therapy After Myocardial Infarction (OBTAIN)
Using Heart Rate Variability to Analyze the Effect of Beta Blockers on Intermediate Risk Patients Undergoing Laparoscopic Surgical Procedures
An Open Label, Randomized Study to Determine the Rate of Cardiovascular Events at 1 yr for Patients With Elevated Troponins Post Major Non-cardiac Surgery and the Impact of Ticagrelor vs Aspirin on the Occurrence of Cardiovascular Events
Changes of Hemodynamics and Vital Organ Function in Intracerebral Hemorrhage During Different General Anesthesia
Comparison of Myocardial Injury After Noncardiac Surgery (MINS) Incidence in Supine vs. Prone Positioning During Percutaneous Nephrolithotomy (PNL)
Who cites it
433 citing papers in PubMed, 16 syntheses or guidelines pooled it.
- Esmolol as an Adjunct in Multimodal Anesthesia: A Systematic Review and Meta-Analysis of Its Opioid-Sparing and Analgesic Effects.Anesthesia and analgesia · 2026Pooled it
- Effect of perioperative autonomic nervous system imbalance on surgical outcomes: a systematic review.British journal of anaesthesia · 2025Pooled it
- Beta-Blocker Use in Patients Undergoing Non-Cardiac Surgery: A Systematic Review and Meta-Analysis.Medical sciences (Basel, Switzerland) · 2024Pooled it
- PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management.British journal of anaesthesia · 2024Guideline
- The impact of long-term antihypertensive treatment on wound healing after major non-cardiac surgery in patients with cardiovascular diseases: A meta-analysis.International wound journal · 2024Pooled it
- Drugs to reduce bleeding and transfusion in major open vascular or endovascular surgery: a systematic review and network meta-analysis.The Cochrane database of systematic reviews · 2023Pooled it
- Global trends in perioperative stroke research from 2003 to 2022: a web of science-based bibliometric and visual analysis.Frontiers in neurology · 2023Pooled it
- Magnesium prophylaxis of new-onset atrial fibrillation: A systematic review and meta-analysis.PloS one · 2023Pooled it
- Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review.Arquivos de neuro-psiquiatria · 2022Pooled it
- Beta-blockers in patients without heart failure after myocardial infarction.The Cochrane database of systematic reviews · 2021Pooled it
- Beta-Blockade in Aneurysmal Subarachnoid Hemorrhage: a Systematic Review and Meta-Analysis.Neurocritical care · 2020Pooled it
- Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment.BMC medicine · 2020Pooled it
- Beta-blockers for suspected or diagnosed acute myocardial infarction.The Cochrane database of systematic reviews · 2019Pooled it
- Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery.The Cochrane database of systematic reviews · 2019Pooled it
- The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019Guideline
- Efficacy and safety of intravenous esmolol for cardiac protection in non-cardiac surgery. A systematic review and meta-analysis.Annals of medicine · 2019Pooled it
- Colchicine to prevent cardiovascular events in thoracic surgery patients with or without coronary artery disease: a secondary analysis.Open heart · 2026Trial
- Continuous vs Intermittent Postoperative Vital Sign Monitoring: A Cluster Randomized Crossover Trial.JAMA network open · 2026Trial
- Favorable safety outcomes of a perioperative propranolol and etodolac regimen in cancer patients in four randomized controlled trials.Frontiers in pharmacology · 2026Trial
- Trial
373 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
Authors and funding
20 authors.
Funding
Abstract
backgroundTrials of beta blockers in patients undergoing non-cardiac surgery have reported conflicting results. This randomised controlled trial, done in 190 hospitals in 23 countries, was designed to investigate the effects of perioperative beta blockers.
methodsWe randomly assigned 8351 patients with, or at risk of, atherosclerotic disease who were undergoing non-cardiac surgery to receive extended-release metoprolol succinate (n=4174) or placebo (n=4177), by a computerised randomisation phone service. Study treatment was started 2-4 h before surgery and continued for 30 days. Patients, health-care providers, data collectors, and outcome adjudicators were masked to treatment allocation. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal cardiac arrest. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00182039.
findingsAll 8351 patients were included in analyses; 8331 (99.8%) patients completed the 30-day follow-up. Fewer patients in the metoprolol group than in the placebo group reached the primary endpoint (244 [5.8%] patients in the metoprolol group vs 290 [6.9%] in the placebo group; hazard ratio 0.84, 95% CI 0.70-0.99; p=0.0399). Fewer patients in the metoprolol group than in the placebo group had a myocardial infarction (176 [4.2%] vs 239 [5.7%] patients; 0.73, 0.60-0.89; p=0.0017). However, there were more deaths in the metoprolol group than in the placebo group (129 [3.1%] vs 97 [2.3%] patients; 1.33, 1.03-1.74; p=0.0317). More patients in the metoprolol group than in the placebo group had a stroke (41 [1.0%] vs 19 [0.5%] patients; 2.17, 1.26-3.74; p=0.0053).
interpretationOur results highlight the risk in assuming a perioperative beta-blocker regimen has benefit without substantial harm, and the importance and need for large randomised trials in the perioperative setting. Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol.
Indexed as
Identifiers
18479744What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.