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Steroids in cardiac surgery: a systematic review and meta-analysis
N Dvirnik1, E P Belley-Cote2, H Hanif3
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada.
British Journal of Anaesthesia
|March 27, 2018
Summary
Prophylactic steroids in cardiac surgery did not affect mortality but increased myocardial injury risk. While they reduced atrial fibrillation in small studies, large trials showed no benefit, suggesting caution.
Area of Science:
- Cardiology
- Pharmacology
- Systemic Inflammation
Background:
- Cardiopulmonary bypass (CPB) triggers a systemic inflammatory response.
- This inflammation may lead to postoperative complications after cardiac surgery.
- Prophylactic steroid use is investigated to mitigate these inflammatory effects and improve patient outcomes.
Purpose of the Study:
- To systematically review the impact of prophylactic steroids on clinical outcomes in patients undergoing on-pump cardiac surgery.
- To evaluate the efficacy of perioperative corticosteroid administration in reducing adverse events.
- To synthesize evidence from randomized controlled trials (RCTs) on steroid use during CPB.
Main Methods:
- Systematic review and meta-analysis of 56 randomized controlled trials (RCTs) published between 1977 and 2015.
- Searched MEDLINE, EMBASE, and Cochrane CENTRAL for relevant studies.
- Assessed outcomes including mortality, myocardial infarction, and new onset atrial fibrillation using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Main Results:
- No significant difference in mortality between steroid and placebo groups (3.0% vs 3.5%, P=0.07).
- Increased risk of myocardial injury in the steroid group (8.0% vs 6.9%, P=0.008).
- New onset atrial fibrillation was lower in the steroid group (25.7% vs 28.3%, P=0.0005), but this effect was limited to small trials.
Conclusions:
- Steroid administration during cardiac surgery has an unclear impact on mortality.
- Prophylactic steroids increase the risk of myocardial injury in patients undergoing CPB.
- Observed benefits for atrial fibrillation in small trials were not replicated in large studies, warranting caution.
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