6/29/23, 1:41 AM POISE Pathway Feedback Search Clinical Topics Home Studies POISE POISE Trial question What is the effect of ER metoprolol succinate in patients undergoing noncardiac surgery? Study design Multi-center Quadruple blinded RCT Population Characteristics of study participants 37.0% female N = 8351 63.0% male 8351 patients (3058 female, 5293 male) Inclusion criteria: patients with, or at risk of, atherosclerotic disease who were undergoing noncardiac surgery Key exclusion criteria: HR under 50 beats/min; second or third-degree heart block; asthma; receiving a -blocker; prior adverse reaction to a -blocker; CABG surgery in the preceding 5 years and no cardiac ischemia since Interventions N=4174 metoprolol succinate (oral ER 100 mg daily 2-4 hours before surgery) N=4177 placebo (matching placebo 2-4 hours before surgery) Primary outcome Cardiovascular death, nonfatal myocardial infarction, or nonfatal cardiac arrest, at 30 days 6.9 % 6.9 5.8 5.2 % 3.5 % Significant decrease 1.7 % https://web.pathway.md/studies/recoKxWyeRr3JstMn 1/2 6/29/23, 1:41 AM POISE Pathway NNT = 91 0.0 % Metoprolol succinate Placebo Significant decrease in cardiovascular death, nonfatal myocardial infarction, or nonfatal cardiac arrest, at 30 days (5.8% vs. 6.9%; HR 0.84, 95% CI 0.7 to 0.99) Secondary outcomes Significant decrease in myocardial infarction (4.2% vs. 5.7%; HR 0.73, 95% CI 0.6 to 0.89) Significant increase in death (3.1% vs. 2.3%; HR 1.33, 95% CI 1.03 to 1.74) Significant increase in stroke (1% vs. 0.5%; HR 2.17, 95% CI 1.26 to 3.74) Safety outcomes Significant differences in clinically significant hypotension (15.0% vs. 9.7%, p < 0.0001) and bradycardia (6.6% vs. 2.4%, p < 0.0001). Conclusion In patients with, or at risk of, atherosclerotic disease who were undergoing noncardiac surgery, metoprolol succinate was superior to placebo with respect to cardiovascular death, nonfatal myocardial infarction, or nonfatal cardiac arrest, at 30 days. Reference POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47. Open reference URL https://web.pathway.md/studies/recoKxWyeRr3JstMn 2/2