Abstract 17426: Preventing Postoperative Atrial Fibrillation in Cardiac Surgery. A Network Meta-analysis to Identify the Best Prophylactic Strategy
Background: Postoperative atrial fibrillation (POAF) remains a major concern following cardiac surgery. Several anti-arrhythmic/anti-inflammatory drugs have been proposed to prevent its occurrance but these strategies remain largely underutilized due to the lack of clear guidance. We aimed to provide the basis for a rational decision in the use of a particular therapy by means of network benefit-risk meta-analysis.
Methods: A systematic review of RCTs on arrhythmic/anti-inflammatory drugs used for the prevention of POAF was conducted. Only treatments investigated in more than 3 trials were included. Treatment withdrawal due to adverse side effect was considered in the benefit-risk analysis. Direct and indirect evidence were combined through a Markov Chain Monte Carlo network meta-analysis.
Results: Fifty-six RCTs were included in the final analysis enrolling a total of 9,913 patients treated with β blockers, amiodarone, sotalol, magnesium, atorvastatin and n-3 polyunsaturated fatty acids. All but n-3 polyunsaturated fatty acids (risk ratio 0.70, 0.48-1.0) were effective to prevent POAF when compared to placebo (Figure, Rank probability for effectiveness). Sotalol was more effective in preventing POAF than β blockers (0.64, 0.45-0.91), magnesium (0.57, 0.34-0.99) and amiodarone (0.68, 0.46-0.98) but it was not significantly superior to atorvastatin (0.93, 0.51-1.74). A trend towards an increased risk for treatment withdrawal was found for sotalol (0.05, 0.02-0.10), β blockers (0.05, 0.02-0.14) and amiodarone (0.04, 0.01-0.12) when compared to atorvastatin (0.0, 0.0-1.0), magnesium (0.0, 0.0-1.0) and n-3 PUFAs (0.0, 0.0-0.96). In the benefit-risk analysis, atorvastatin achieved the highest probability (73%) to be the preferred alternative followed by sotalol (47%) and magnesium (9%).
Conclusions: Among proposed treatments for preventing POAF, atorvastatin should be used as first line strategy due to its favorable benefit-risk profile.
- © 2013 by American Heart Association, Inc.