TY - JOUR
T1 - Steroids in cardiac surgery
T2 - a systematic review and meta-analysis
AU - Dvirnik, N
AU - Belley-Cote, E P
AU - Hanif, H
AU - Devereaux, P J
AU - Lamy, A
AU - Dieleman, J M
AU - Vincent, J
AU - Whitlock, R P
N1 - Funding Information:
N.D., E.P.BC., R.P.W, H.H., A.L., J.M.D., and J.V. have no conflict of interest to declare. PJ.D. is a member of a research group with a policy of not accepting honorariums or other payments from industry for their own personal financial gain. They do accept honorariums/payments from industry to support research endeavours and costs to participate in meetings. PJ.D. has received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics, and Stryker. PJ.D. has participated in an advisory board meeting for GlaxoSmithKline and an expert panel meeting with AstraZeneca and Boehringer Ingelheim.
Funding Information:
N.D., E.P.BC., R.P.W, H.H., A.L., J.M.D., and J.V. have no conflict of interest to declare. PJ.D. is a member of a research group with a policy of not accepting honorariums or other payments from industry for their own personal financial gain. They do accept honorariums/payments from industry to support research endeavours and costs to participate in meetings. PJ.D. has received grants from Abbott Diagnostics , AstraZeneca , Bayer , Boehringer Ingelheim , Bristol-Myers Squibb , Coviden , Octapharma , Philips Healthcare , Roche Diagnostics , and Stryker . PJ.D. has participated in an advisory board meeting for GlaxoSmithKline and an expert panel meeting with AstraZeneca and Boehringer Ingelheim.
Publisher Copyright:
© 2018 British Journal of Anaesthesia
PY - 2018/4
Y1 - 2018/4
N2 - BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction that may contribute to postoperative complications. Preventing this reaction with steroids may improve outcomes. We performed a systematic review to evaluate the impact of prophylactic steroids on clinical outcomes in patients undergoing on-pump cardiac surgery.METHODS: We searched MEDLINE, EMBASE, and Cochrane CENTRAL for randomised controlled trials (RCTs) comparing perioperative corticosteroid administration with a control group in adults undergoing CPB. Outcomes of interest included mortality, myocardial infarction, and new onset atrial fibrillation. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.RESULTS: Fifty-six RCTs published between 1977 and 2015 were included in this meta-analysis. Mortality was not significantly different between groups [3.0% (215/7258 patients) in the steroid group and 3.5% (252/7202 patients) in the placebo group; relative risk (RR), 0.85; 95% confidence interval (CI), 0.71-1.01; P=0.07; I2 = 0%]. Myocardial injury was more frequent in the steroid group [8.0% (560/6989 patients), compared with 6.9% (476/6929 patients); RR, 1.17, 95% CI, 1.04-1.31; P=0.008; I2=0%]. New onset atrial fibrillation was lower in the steroid group [25.7% (1792/6984 patients) compared with 28.3% (1969/6964 patients), RR, 0.91, 95% CI, 0.86-0.96, P=0.0005, I2=43%]; this beneficial effect was limited to small trials (P for interaction <0.00001).CONCLUSIONS: After randomising 16 013 patients, steroid administration at the time of cardiac surgery had an unclear impact on mortality, increased the risk of myocardial injury, and the impact on atrial fibrillation should be viewed with caution given that large trials showed no effect.
AB - BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction that may contribute to postoperative complications. Preventing this reaction with steroids may improve outcomes. We performed a systematic review to evaluate the impact of prophylactic steroids on clinical outcomes in patients undergoing on-pump cardiac surgery.METHODS: We searched MEDLINE, EMBASE, and Cochrane CENTRAL for randomised controlled trials (RCTs) comparing perioperative corticosteroid administration with a control group in adults undergoing CPB. Outcomes of interest included mortality, myocardial infarction, and new onset atrial fibrillation. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.RESULTS: Fifty-six RCTs published between 1977 and 2015 were included in this meta-analysis. Mortality was not significantly different between groups [3.0% (215/7258 patients) in the steroid group and 3.5% (252/7202 patients) in the placebo group; relative risk (RR), 0.85; 95% confidence interval (CI), 0.71-1.01; P=0.07; I2 = 0%]. Myocardial injury was more frequent in the steroid group [8.0% (560/6989 patients), compared with 6.9% (476/6929 patients); RR, 1.17, 95% CI, 1.04-1.31; P=0.008; I2=0%]. New onset atrial fibrillation was lower in the steroid group [25.7% (1792/6984 patients) compared with 28.3% (1969/6964 patients), RR, 0.91, 95% CI, 0.86-0.96, P=0.0005, I2=43%]; this beneficial effect was limited to small trials (P for interaction <0.00001).CONCLUSIONS: After randomising 16 013 patients, steroid administration at the time of cardiac surgery had an unclear impact on mortality, increased the risk of myocardial injury, and the impact on atrial fibrillation should be viewed with caution given that large trials showed no effect.
KW - cardiac surgical procedures
KW - cardiopulmonary bypass
KW - cardiovascular diseases
KW - postoperative complications
KW - steroids
KW - Systemic Inflammatory Response Syndrome/etiology
KW - Adrenal Cortex Hormones/therapeutic use
KW - Cardiopulmonary Bypass/adverse effects
KW - Humans
KW - Cardiac Surgical Procedures/adverse effects
UR - http://www.scopus.com/inward/record.url?scp=85045929942&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2017.10.025
DO - 10.1016/j.bja.2017.10.025
M3 - Review article
C2 - 29576107
SN - 0007-0912
VL - 120
SP - 657
EP - 667
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 4
ER -