背景:术后心房颤动(POAF)是心脏手术后最常见的心律失常并发症。目前的指南建议β受体阻滞剂用于预防POAF。在比较琥珀酸美托洛尔和卡维地洛时,后来引起了人们对将其用作预防POAF的重要药物的兴趣。
方法:我们考虑了随机对照研究(RCT)和回顾性研究,评估了卡维地洛与美托洛尔预防POAF的疗效。经过文献检索,数据提取,和质量评估,使用ReviewManager5.3使用固定效应或随机效应模型分析合并数据.使用Cochrane偏倚风险工具评估纳入研究的偏倚。POAF的发生率是主要终点,而死亡率和心动过缓是次要结局.
结果:在荟萃分析中,纳入了5项RCTs和2项回顾性研究,共1000例患者。总体效果在死亡率方面与美托洛尔组相比,卡维地洛[风险比0.45,95%CI(0.1-1.97),P=0.29]或心动过缓的发生率[风险比0.63,95%CI(0.32-1.23),P=0.17]。然而,与美托洛尔相比,接受卡维地洛的患者的POAF发生率较低[风险比0.54,95%CI(0.42-0.71),P<0.00001]。
结论:在接受心脏手术的患者中,卡维地洛可以比美托洛尔更有效地减少POAF的发生。为了明确确定卡维地洛与美托洛尔和其他β受体阻滞剂在预防POAF方面的疗效,大规模,需要精心设计的随机对照试验.
BACKGROUND: Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. Current guidelines suggest beta-blockers for the prevention of POAF. In comparing metoprolol succinate with carvedilol, the later has sparked interest in its usage as an important medication for POAF prevention.
METHODS: We considered randomized controlled studies (RCTs) and retrospective studies that evaluated the efficacy of carvedilol versus metoprolol for the prevention of POAF. After literature search, data extraction, and quality evaluation, pooled data were analyzed using either the fixed-effect or random-effect model using Review Manager 5.3. The Cochrane risk of bias tool was used to assess the bias of included studies. The incidence of POAF was the primary endpoint, while mortality rate and bradycardia were secondary outcomes.
RESULTS: In meta-analysis 5 RCTs and 2 retrospective studies with a total of 1000 patients were included. The overall effect did not favor the carvedilol over metoprolol groups in terms of mortality rate [risk ratio 0.45, 95 % CI (0.1-1.97), P=0.29] or incidence of bradycardia [risk ratio 0.63, 95 % CI (0.32-1.23), P=0.17]. However, the incidence of POAF was lower in patients who received carvedilol compared to metoprolol [risk ratio 0.54, 95 % CI (0.42-0.71), P < 0.00001].
CONCLUSIONS: In patients undergoing cardiac surgery, carvedilol may minimize the occurrence of POAF more effectively than metoprolol. To definitively establish the efficacy of carvedilol compared to metoprolol and other beta-blockers in the prevention of POAF, a large-scale, well-designed randomized controlled trials are required.