Effectiveness of Anti-Inflammatory Agents to Prevent Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2025-01-01 DOI:10.1016/j.cjco.2024.10.008

Alireza Malektojari MD , Zahra Javidfar , Sara Ghazizadeh MD , Shaghayegh Lahuti MD , Rahele Shokraei MD , Mohadeseh Zeinaee , Amirhosein Badele , Raziyeh Mirzadeh , Mitra Ashrafi MD , Fateme Afra , Mohammad Hamed Ersi , Marziyeh Heydari , Ava Ziaei MD , Zohreh Rezvani , Jasmine Mah MD, MSc , Dena Zeraatkar PhD , Shahin Abbaszadeh MD, AP , Tyler Pitre MD, MA

{"title":"Effectiveness of Anti-Inflammatory Agents to Prevent Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis","authors":"Alireza Malektojari MD , Zahra Javidfar , Sara Ghazizadeh MD , Shaghayegh Lahuti MD , Rahele Shokraei MD , Mohadeseh Zeinaee , Amirhosein Badele , Raziyeh Mirzadeh , Mitra Ashrafi MD , Fateme Afra , Mohammad Hamed Ersi , Marziyeh Heydari , Ava Ziaei MD , Zohreh Rezvani , Jasmine Mah MD, MSc , Dena Zeraatkar PhD , Shahin Abbaszadeh MD, AP , Tyler Pitre MD, MA","doi":"10.1016/j.cjco.2024.10.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Preventing postoperative atrial fibrillation (POAF) as one of the most significant complications of cardiovascular surgeries remains a major clinical challenge. We conducted a systematic review with network meta-analysis of randomized controlled trials, to identify the most effective and safe anti-inflammatory drugs to prevent new-onset POAF.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, Web of Science, and Cochrane Library were searched without language or publication-date restriction on August 8, 2022 (updated on August 8, 2023). We assessed the risk of bias of included trials using the Cochrane risk-of-bias 2.0 tool. We conducted a frequentist random-effects network meta-analysis in R, and we assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.</div></div><div><h3>Results</h3><div>A total of 85 trials reported the incidence of new-onset POAF, including 18,981 patients. Use of nonsteroidal anti-inflammatory drugs (relative risk [RR] 0.37 [95% confidence interval [CI] 0.23-0.59]) and statins (RR 0.56 [95% CI 0.45-0.7]) potentially reduced the risk of POAF compared with placebo (both with a moderate certainty level). Use of fish oil in combination with vitamins C and E (RR 0.30 [95% CI 0.13-0.68]) may reduce the risk of POAF, compared with placebo (low level of certainty). Use of colchicine (RR 0.62 [95% CI 0.45- 0.85]), corticosteroids (RR 0.70 [95% CI 0.59-0.82]), and N-acetylcysteine (RR 0.69 [95% CI 0.49- 0.98]) may reduce the risk of POAF (all with a low level of certainty). None of the interventions had a significant effect on mortality rate or risk of serious adverse effects.</div></div><div><h3>Conclusions</h3><div>Use of nonsteroidal anti-inflammatory drugs and statins probably are effective in preventing new-onset POAF, with a moderate level of certainty, compared to placebo.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 35-45"},"PeriodicalIF":2.5000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763850/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X24005134","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Preventing postoperative atrial fibrillation (POAF) as one of the most significant complications of cardiovascular surgeries remains a major clinical challenge. We conducted a systematic review with network meta-analysis of randomized controlled trials, to identify the most effective and safe anti-inflammatory drugs to prevent new-onset POAF.

Methods

MEDLINE, Embase, Web of Science, and Cochrane Library were searched without language or publication-date restriction on August 8, 2022 (updated on August 8, 2023). We assessed the risk of bias of included trials using the Cochrane risk-of-bias 2.0 tool. We conducted a frequentist random-effects network meta-analysis in R, and we assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

Results

A total of 85 trials reported the incidence of new-onset POAF, including 18,981 patients. Use of nonsteroidal anti-inflammatory drugs (relative risk [RR] 0.37 [95% confidence interval [CI] 0.23-0.59]) and statins (RR 0.56 [95% CI 0.45-0.7]) potentially reduced the risk of POAF compared with placebo (both with a moderate certainty level). Use of fish oil in combination with vitamins C and E (RR 0.30 [95% CI 0.13-0.68]) may reduce the risk of POAF, compared with placebo (low level of certainty). Use of colchicine (RR 0.62 [95% CI 0.45- 0.85]), corticosteroids (RR 0.70 [95% CI 0.59-0.82]), and N-acetylcysteine (RR 0.69 [95% CI 0.49- 0.98]) may reduce the risk of POAF (all with a low level of certainty). None of the interventions had a significant effect on mortality rate or risk of serious adverse effects.

Conclusions

Use of nonsteroidal anti-inflammatory drugs and statins probably are effective in preventing new-onset POAF, with a moderate level of certainty, compared to placebo.

查看原文