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Calcium antagonists reduce cardiovascular complications after cardiac surgery: a meta-analysis
Duminda N Wijeysundera1, W Scott Beattie, Vivek Rao
1Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Insights
Calcium antagonists (CAs) significantly reduced myocardial infarction, ischemia, and supraventricular tachycardia after cardiac surgery. Further research is recommended to confirm these benefits for patient outcomes.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Calcium antagonists (CAs) show potential in reducing post-cardiac surgery complications like myocardial infarction (MI) and renal failure.
- Previous observational studies may have contributed to the underutilization of CAs in this patient population.
Purpose of the Study:
- To evaluate the efficacy of calcium antagonists (CAs) in mitigating adverse events following cardiac surgery.
- Key outcomes assessed include mortality, myocardial infarction (MI), ischemia, and supraventricular tachyarrhythmia (SVT).
Main Methods:
- A comprehensive literature search of MEDLINE and EMBASE databases was conducted (up to December 2001).
- Included were randomized controlled trials (RCTs) examining preoperative, intraoperative, or early postoperative CA use in aortocoronary bypass or valve surgery.
- Forty-one RCTs involving 3,327 patients were analyzed using a random-effects model to assess treatment effects and heterogeneity.
Main Results:
- Calcium antagonists demonstrated a significant reduction in myocardial infarction (MI) (OR 0.58, p=0.02) and ischemia (OR 0.53, p<0.001).
- Non-dihydropyridine calcium antagonists significantly decreased the incidence of supraventricular tachyarrhythmia (SVT) (OR 0.62, p=0.02).
- A trend towards reduced mortality was observed with CA use during aortocoronary bypass surgery, though not statistically significant (OR 0.66, p=0.4).
Conclusions:
- The findings indicate that calcium antagonists are effective in significantly lowering rates of MI, ischemia, and SVT in patients undergoing cardiac surgery.
- The results support the need for further large-scale randomized controlled trials to solidify the role of CAs in cardiac surgical care.
Objectives:
We sought to determine the efficacy of calcium antagonists (CAs) in reducing death, myocardial infarction (MI), ischemia, and supraventricular tachyarrhythmia (SVT) after cardiac surgery.
Background:
Calcium antagonists may reduce complications after cardiac surgery-namely, death, MI, and renal failure. However, they are underused, possibly due to the results from previous observational studies.
Methods:
Both MEDLINE (1966 to December 2001) and EMBASE (1980 to December 2001) were searched, with supplementation by reference list searches. No language restrictions were applied. Included studies were randomized, controlled trials (RCTs) evaluating preoperative, intraoperative, or postoperative (first 48 h) CA use (intravenous or oral) during aortocoronary bypass or valve surgery. Studies were excluded if they exclusively recruited transplant recipients, individuals <18 years old, or patients with pre-existing SVT. Two reviewers independently evaluated study quality by using the Jadad score; a minimal score of 1/5 was required. Forty-one studies, encompassing 3,327 patients, were included. No studies assessed treatment exclusively with short-acting oral nifedipine. Treatment effects were calculated using the random-effects model. Heterogeneity was assessed using the Q test.
Results:
Calcium antagonists significantly reduced MI (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.91; p = 0.02) and ischemia (OR 0.53, 95% CI 0.39 to 0.72; p < 0.001). Non-dihydropyridines significantly reduced SVT (OR 0.62, 95% CI 0.41 to 0.93; p = 0.02). Calcium antagonists were associated with trends toward decreased mortality during aortocoronary bypass (OR 0.66, 95% CI 0.26 to 1.70, p = 0.4).
Conclusions:
Use of CAs during cardiac surgery significantly reduced rates of MI, ischemia, and SVT. Further study using large RCTs is justified.