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CLINICAL STUDY

Calcium antagonists reduce cardiovascular complications after cardiac surgery

A meta-analysis

Duminda N. Wijeysundera, MD^*, W. Scott Beattie, MD, PhD^,*, Vivek Rao, MD, PhD and Jacek Karski, MD

^* Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Manuscript received July 23, 2002; revised manuscript received November 13, 2002, accepted November 27, 2002.

^* Reprint requests and correspondence: Dr. W. Scott Beattie, Associate Professor, Department of Anaesthesia, University of Toronto, EN 3-453, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
scott.beattie{at}uhn.on.ca

OBJECTIVES: We sought to determine the efficacy of calcium antagonists (CAs) in reducing death, myocardial infarction (MI), ischemia, and supraventricular tachyarrhythmia (SVT) after cardiac surgery.

BACKGROUND: Calcium antagonists may reduce complications after cardiac surgery—namely, death, MI, and renal failure. However, they are underused, possibly due to the results from previous observational studies.

METHODS: Both MEDLINE (1966 to December 2001) and EMBASE (1980 to December 2001) were searched, with supplementation by reference list searches. No language restrictions were applied. Included studies were randomized, controlled trials (RCTs) evaluating preoperative, intraoperative, or postoperative (first 48 h) CA use (intravenous or oral) during aortocoronary bypass or valve surgery. Studies were excluded if they exclusively recruited transplant recipients, individuals <18 years old, or patients with pre-existing SVT. Two reviewers independently evaluated study quality by using the Jadad score; a minimal score of 1/5 was required. Forty-one studies, encompassing 3,327 patients, were included. No studies assessed treatment exclusively with short-acting oral nifedipine. Treatment effects were calculated using the random-effects model. Heterogeneity was assessed using the Q test.

RESULTS: Calcium antagonists significantly reduced MI (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.91; p = 0.02) and ischemia (OR 0.53, 95% CI 0.39 to 0.72; p < 0.001). Non-dihydropyridines significantly reduced SVT (OR 0.62, 95% CI 0.41 to 0.93; p = 0.02). Calcium antagonists were associated with trends toward decreased mortality during aortocoronary bypass (OR 0.66, 95% CI 0.26 to 1.70, p = 0.4).

CONCLUSIONS: Use of CAs during cardiac surgery significantly reduced rates of MI, ischemia, and SVT. Further study using large RCTs is justified.

Abbreviations and Acronyms   CA = calcium antagonist   CABG = coronary artery bypass graft surgery   MI = myocardial infarction   RCT = randomized, controlled trial   SVT = supraventricular tachyarrhythmia

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