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Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis

Duminda N Wijeysundera1, W Scott Beattie

  • 1From the *Department of Anesthesia, University of Toronto, and the †Department of Anesthesia, University Health Network, University of Toronto, Toronto, ON.

Anesthesia and Analgesia
|August 23, 2003
PubMed

Insights

Calcium channel blockers (CCBs) significantly reduce cardiac ischemia and supraventricular tachyarrhythmia during noncardiac surgery. Diltiazem, in particular, shows promise in reducing major adverse cardiac events, warranting further investigation.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pharmacology

Background:

  • Cardiac complications are a leading cause of mortality post-noncardiac surgery.
  • Calcium channel blockers (CCBs) have theoretical benefits but are underutilized perioperatively.

Purpose of the Study:

  • To systematically review the efficacy of CCBs in reducing cardiac complications during noncardiac surgery.
  • To assess the impact of CCBs on mortality, myocardial infarction, ischemia, arrhythmias, and heart failure.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched major databases (MEDLINE, EMBASE, PubMed, etc.) without language restriction.
  • Extracted data on key cardiac outcomes; calculated relative risks (RR) with 95% confidence intervals (CI).

Main Results:

  • CCBs significantly reduced cardiac ischemia (RR, 0.49; 95% CI, 0.30-0.80) and supraventricular tachyarrhythmia (SVT) (RR, 0.52; 95% CI, 0.37-0.72).
  • Post hoc analyses showed CCBs reduced death/myocardial infarction (MI) (RR, 0.35; 95% CI, 0.15-0.86) and major morbid events (MME) (RR, 0.39; 95% CI, 0.17-0.89).
  • Diltiazem was specifically associated with significant reductions in ischemia, SVT, death/MI, and MME.

Conclusions:

  • CCBs are effective in reducing cardiac ischemia, SVT, and combined endpoints in the perioperative setting of noncardiac surgery.
  • Diltiazem appears to be a key driver of these benefits, suggesting its potential role.
  • Further large-scale RCTs are needed to confirm these findings and evaluate diltiazem's role.

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