According to a study in BMC Cardiovascular Disorders, the most common arrhythmia after cardiac surgery is postoperative atrial fibrillation (POAF), which is closely linked to inflammation. The study’s authors conducted a meta-analysis on different doses of glucocorticoids in patients with POAF.
Based on their data, the investigators found glucocorticoid use appeared to reduce the severity of POAF. Furthermore, analyses of subgroups showed that low-dose glucocorticoids were more effective than high-dose in preventing POAF, and that glucocorticoids appeared to reduce the incidence of POAF in coronary artery bypass graft (CABG) alone.
POAF Possibly Prevented by Glucocorticoids in CABG
The pooled cohort contained 14,442 patients from 27 studies that were published to the PubMed, Embase, Web of Science, and Cochrane Library databases. Subgroup comparisons included different surgeries and glucocorticoid doses. Researchers also assessed the potential impact of glucocorticoids on infection and gastrointestinal injury.
Based on random-effects models, authors observed the incidence of POAF was lower in the glucocorticoid group compared with the non-glucocorticoid group (risk ratio [RR], 0.80; 95% CI, 0.71-0.92; P=.001). Low doses of glucocorticoids reduced the incidence of POAF (RR, 0.81; 95% CI, 0.71-0.92; P=.001), while high-dose glucocorticoids did not have a significant effect (RR, 0.81; 95% CI, 0.56-1.19; P=.286).
Among 13 studies that reported postoperative infections, the authors calculated that glucocorticoid use did not increase the risk of infections (RR, 0.85; 95% CI, 0.68-1.06; P=.158). Likewise, analysis of 8 studies that reported on gastrointestinal diseases showed no differences between glucocorticoid and non-glucocorticoid groups (RR, 1.12; 95% CI, 0.83-1.50; P=.450).
While the study’s limitations led the authors to only cautiously recommend glucocorticoids, they summarized that “the results of this study showed that glucocorticoids were beneficial in reducing the effect of POAF, and low-dose glucocorticoids could reduce the incidence of POAF. ”
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