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Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized Controlled Trials

Fang Mingxing1, Giovanni Landoni2, Alberto Zangrillo2

  • 1Department of Intensive Care, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, P.R. China.

Journal of Cardiothoracic and Vascular Anesthesia
|February 8, 2018
PubMed

Insights

Phosphocreatine (PCr) may improve cardiac surgery outcomes by reducing arrhythmias and the need for inotropic support. While PCr showed benefits in recovery, further large-scale studies are needed for clinical significance validation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biochemistry

Background:

  • Phosphocreatine (PCr) has shown potential in mitigating ischemia/reperfusion injury in the heart.
  • Cardiac surgery patients are at risk for myocardial damage and arrhythmias.

Purpose of the Study:

  • To evaluate the efficacy of phosphocreatine (PCr) in improving cardiac performance and outcomes in patients undergoing cardiac surgery compared to standard treatment.
  • To assess PCr's impact on intraoperative support, arrhythmias, and postoperative cardiac function.

Main Methods:

  • A meta-analysis of 26 randomized controlled trials involving 1,948 adult and pediatric patients undergoing cardiac surgery.
  • Searched multiple databases including PubMed/Medline, Embase, Scopus, and Cochrane Library up to March 1, 2017.
  • Analyzed data using random and fixed-effects models to calculate odds ratios and mean differences.

Main Results:

  • PCr use was linked to significantly lower rates of intraoperative inotropic support (27% vs. 44%) and major arrhythmias (16% vs. 28%).
  • Patients receiving PCr demonstrated a higher spontaneous recovery of cardiac rhythm post-aortic declamping (50% vs. 34%).
  • PCr administration showed a trend towards decreased myocardial damage and improved left ventricular ejection fraction, though these effects were not clinically significant.

Conclusions:

  • Phosphocreatine (PCr) administration in cardiac surgery is associated with reduced intraoperative inotropic support and major arrhythmias.
  • PCr may enhance spontaneous cardiac rhythm recovery after aortic declamping.
  • Larger multicenter trials are necessary to confirm these findings and establish clinical significance.
Abstract

Keywords:
cardiac surgeryenergy metabolisminotropic supportischemia/reperfusion injuryperioperative periodphosphocreatine

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