SynthesisAnnals of surgery2009
Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV).
Synthesis in Annals of surgery, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01543555 (Multicenter Randomized Controlled Trial of Loading Dose Statins for the Prevention of Cardiovascular Complications in High-Risk Non-Cardiac Surgery), which is not on this map. Cited by 51 papers, 13 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 graphWho cites it
51 citing papers in PubMed, 13 syntheses or guidelines pooled it.
- Beta-Blocker Use in Patients Undergoing Non-Cardiac Surgery: A Systematic Review and Meta-Analysis.Medical sciences (Basel, Switzerland) · 2024Pooled 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
- Perioperative beta-blockers for preventing surgery-related mortality and morbidity.The Cochrane database of systematic reviews · 2018Pooled it
- Guideline
- Pharmacological treatment of vascular risk factors for reducing mortality and cardiovascular events in patients with abdominal aortic aneurysm.The Cochrane database of systematic reviews · 2017Pooled it
- Does short preoperative statin therapy prevent infectious complications in adults undergoing cardiac or non-cardiac surgery? A meta-analysis of 5 randomized placebo-controlled trials.Saudi medical journal · 2016Pooled it
- HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass.The Cochrane database of systematic reviews · 2015Pooled it
- 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2015Guideline
- Beta-adrenergic blockers for perioperative cardiac risk reduction in people undergoing vascular surgery.The Cochrane database of systematic reviews · 2015Pooled it
- Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery.Heart (British Cardiac Society) · 2014Pooled it
- Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery.The Cochrane database of systematic reviews · 2013 · on this mapPooled it
- 3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology.Arquivos brasileiros de cardiologiaGuideline
- Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study.Scientific reports · 2021Trial
- Remote ischemic preconditioning for cardioprotection in elective inpatient abdominal surgery - a randomized controlled trial.BMC anesthesiology · 2018Trial
- Patterns of β-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery.American heart journal · 2015Trial
- Preoperative statin use and postoperative mortality in cardiac surgery patients: a retrospective cohort study of the MIMIC-IV database.Journal of thoracic disease · 2026Article
- Review
- The Impact of Age on the Post-operative Outcomes in Patients Undergoing Resection for Oesophageal and Gastric Cancer.World journal of surgery · 2023Article
- Assessment and Management of Ischaemic Heart Disease in Non-Cardiac Surgery.Heart international · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study evaluated the effectiveness and safety of beta-blockers and statins for the prevention of perioperative cardiovascular events in intermediate-risk patients undergoing noncardiovascular surgery. SUMMARY BACKGROUND DATA: Beta-blockers and statins reduce perioperative cardiac events in high-risk patients undergoing vascular surgery by restoring the myocardial oxygen supply/demand balance and/or stabilizing coronary plaques. However, their effects in intermediate-risk patients remained ill-defined.
methodsIn this randomized open-label 2 x 2 factorial design trial 1066 intermediate cardiac risk patients were assigned to bisoprolol, fluvastatin, combination treatment, or control therapy before surgery (median: 34 days). Intermediate risk was defined by an estimated risk of perioperative cardiac death and myocardial infarction (MI) of 1% to 6%, using clinical data and type of surgery. Starting dose of bisoprolol was 2.5 mg daily, titrated to a perioperative heart rate of 50 to 70 beats per minute. Fluvastatin was prescribed in a fixed dose of 80 mg. The primary end point was the composite of 30-day cardiac death and MI. This study is registered in the ISRCTN registry and has the ID number ISRCTN47637497.
resultsPatients randomized to bisoprolol (N = 533) had a lower incidence of perioperative cardiac death and nonfatal MI than those randomized to bisoprolol-control (2.1% vs. 6.0% events; hazard ratios: 0.34; 95% confidence intervals: 0.17-0.67; P = 0.002). Patients randomized to fluvastatin experienced a lower incidence of the end point than those randomized to fluvastatin-control therapy (3.2% vs. 4.9% events; hazard ratios: 0.65; 95% confidence intervals: 0.35-1.10), but statistical significance was not reached (P = 0.17).
conclusionBisoprolol was associated with a significant reduction of 30-day cardiac death and nonfatal MI, while fluvastatin showed a trend for improved outcome.
Indexed as
Identifiers
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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.