Table 3.

Characteristics of the 11 included randomised controlled trials

Study (intervention/control)	Date	Methods	Participants	Type of surgeries	Interventions	Follow-up
Mangano (99/101)	1996	Randomised double-blind placebo-controlled trial	Inclusion: previous myocardial infarction (MI), typical angina or atypical angina with a positive stress test, or at risk of coronary artery disease (CAD) as indicated by two of: age >65, hypertension, current smoking, cholesterol concentration >6.2 mmol/L and diabetes	Major vascular, intra-abdominal, orthopaedic, neurosurgical or other surgery	5–10 mg intravenous (IV) or 50–100 mg oral atenolol 30 min pre surgery and continued until discharge, or a maximum of 7 days post surgery	6-month, 1-year and 2-year outcomes
Bayliff (49/50)	1999	Randomised double-blind placebo-controlled trial	Inclusion: age >18. Exclusion: asthma, congestive heart failure (CHF), second or third degree heart block, history of supraventricular tacchyarrythmias, on a β-blocker, diltiazem, digoxin, quinidine, procainamide, amiodarone, verapamil, or sensitivity to β-blockers	Lobectomies, pneumonectomies, oesophagectomies.	Propanolol 10 mg four times 1 day pre surgery, and continued for 5 days post surgery	Outcomes at hospital discharge
DECREASE I (59/53)	1999	Randomised controlled study	Inclusion: at least one cardiac risk factor (age >70 years, prior MI, CHF, ventricular arrhythmia, diabetes, limited exercise capacity), who had a positive dobutamine echocardiogram (DSE). Exclusion: already on β-blockers, extensive wall motion abnormalities, asthma	Elective vascular surgery	5–10 mg oral bisoprolol from an average of 37 (at least 7) days pre surgery and continued for 30 days post surgery	30-day outcomes
POBBLE (55/48)	2005	Randomised double-blind placebo-controlled trial	Inclusion: all patients not excluded. Exclusion: already taking or intolerant to β-blockers, asthma, aortic stenosis, bradycardia, hypotension, previous MI in the past 2 years, unstable angina or angina with a positive DSE	Vascular surgery	Oral or intravenous metoprolol day before surgery, then 25–50 mg oral metoprolol twice a day until 7 days after surgery	30-day outcomes
DIPOM (462/459)	2006	Randomised double-blind placebo-controlled trial	Inclusion: age >39 years, with diabetes. Exclusion: on or allergic to β-blockers, NYHA class IV, third degree atrioventricular block, pregnant, breast feeding or in previous DIPOM trial	Orthopedic, intra-abdominal, neurological, vascular, gynaecological or other surgery	50–100 mg oral metoprolol 1 day before surgery and continued until hospital discharge, or a maximum of 8 days post surgery	Median follow-up of 18 months (range 6–30 months)
MaVS (246/250)	2006	Randomised double-blind placebo-controlled trial	Inclusion: ASA class ≤3. Exclusion: current or recent β-blocker use, amiodarone, airflow obstruction requiring treatment, history of CHF or atrioventricular (AV) block, previous adverse reaction, previous participation in MaVS study	Vascular surgery	25–100 mg oral metoprolol within 2 h pre surgery, then oral or IV metoprolol until hospital discharge or 5 days post surgery	30-day and 6-month outcomes
Neary (18/20)	2006	Randomised placebo-controlled trial	Inclusion: one of previous MI or ischaemia on ECG, history of angina, history of stroke or transient ischaemic attack; or two of age >65 years, hypertension, current smoking, cholesterol > 6.2 mmol/L, diabetes. Exclusion: already on or intolerant to β-blockers, bradycardia, COPD or asthma, second or third degree heart block, cardiovascular collapse or hypovolaemia, anaesthetist feels patient not fit for β-blockers	Emergency general or orthopaedic surgery	1.25 mg IV atenolol in the anaesthetic room, then every 30 min during surgery, then oral or IV atenolol daily for 7 days post surgery	Mortality to hospital discharge and at 1 year
BBSA (110/109)	2007	Randomised double-blind placebo-controlled trial	Inclusion: CAD indicated by previous MI, angina, atypical angina with a positive stress test or previous coronary procedure or the presence of at least two of: hypertension, diabetes, hypercholesterolaemia, age >65 years and active smoking, Exclusion: chronic β-blockade, CHF, high degree AV block active asthma, left bundle branch block	Orthopaedic, urological, abdominal, gynaecological, plastic or vascular surgery	5–10 mg oral bisoprolol 3 h before surgery and continued until hospital discharge or a maximum of 10 days post surgery	30-day and 1-year outcomes
POISE (4174/4177)	2008	Randomised double-blind placebo-controlled trial	Inclusion: age >45 years, with a history of CAD, peripheral vascular disease, stroke, hospitalisation for CHF within the last 3 years, or with 3 of the following: intrathoracic or intraperitoneal surgery, CHF, transient ischaemic attack, creatinine >175 μmol/L, >70 years old, diabetes or undergoing emergent or urgent surgery	Vascular, intraperitoneal, orthopaedic surgery	100 mg oral extended-release metoprolol 2–4 h pre surgery and then 200 mg once a day for 30 days post surgery	30-day outcomes
Yang (51/51)	2008	Randomised double-blind placebo-controlled trial	Inclusion: age >45 years and a history of CAD or peripheral vascular disease, stroke or hospitalisation for CHF in the last 3 years or any three of the following: high-risk surgery, CHF, diabetes, age >65 years, hypertensive, smoker or high cholesterol. Exclusion: heart rate <50, pacemaker, high degree AV block, active recent asthma, bronchospasm, COPD, adverse reaction to β-blockers, low-risk surgery, taking verapamil, liver or kidney dysfunction, emergency surgery	Intrathoracic or intra-abdominal surgery	Oral or IV metoprolol from 2 h before surgery to 30 days after surgery	30-day outcomes
DECREASE IV (533/533)	2009	Randomised open-label placebo-controlled trial	Inclusion: age >40 years with an estimated risk of perioperative cardiovascular event of 1–6% Exclusion: already on or contraindication to a β-blocker or statin, previous participation in the trial, inability to consent, emergency surgery	General, urological, orthopaedic, ear nose and throat, gynaecological, plastic or other surgery	2.5–10 mg oral bisoprolol started a median of 34 days pre surgery and continued for 30 days post surgery	30-day outcomes

ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease.