Preemptive Pharmacogenetic-Guided Metoprolol Management for Postoperative Atrial Fibrillation in Cardiac Surgery: The Preemptive Pharmacogenetic-Guided Metoprolol Management for Atrial Fibrillation in Cardiac Surgery Pilot Trial.

Autor: Staben R; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN., Vnencak-Jones CL; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN., Shi Y; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN., Shotwell MS; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN., Absi T; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN., Shah AS; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN., Wanderer JP; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN., Beller M; Center for Precision Medicine, Vanderbilt University Medical Center, Nashville, TN., Kertai MD; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: miklos.kertai@vumc.org.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2023 Oct; Vol. 37 (10), pp. 1974-1982. Date of Electronic Publication: 2023 Jun 14.
DOI: 10.1053/j.jvca.2023.06.017
Abstrakt: Objectives: To test the hypothesis that implementation of a cytochrome P-450 2D6 (CYP2D6) genotype-guided perioperative metoprolol administration will reduce the risk of postoperative atrial fibrillation (AF), the authors conducted the Preemptive Pharmacogenetic-Guided Metoprolol Management for Atrial Fibrillation in Cardiac Surgery pilot study.
Design: Clinical pilot trial.
Setting: Single academic center.
Participants: Seventy-three cardiac surgery patients.
Measurements and Main Results: Patients were classified as normal, intermediate, poor, or ultrarapid metabolizers after testing for their CYP2D6 genotype. A clinical decision support tool in the electronic health record advised providers on CYP2D6 genotype-guided metoprolol dosing. Using historical data, the Bayesian method was used to compare the incidence of postoperative AF in patients with altered metabolizer status to the reference incidence. A logistic regression analysis was performed to study the association between the metabolizer status and postoperative AF while controlling for the Multicenter Study of Perioperative Ischemia AF Risk Index. Of the 73 patients, 30% (n = 22) developed postoperative AF; 89% (n = 65) were normal metabolizers; 11% (n = 8) were poor/intermediate metabolizers; and there were no ultrarapid metabolizer patients identified. The estimated rate of postoperative AF in patients with altered metabolizer status was 30% (95% CI 8%-60%), compared with the historical reference incidence (27%). In the risk-adjusted analysis, there was insufficient evidence to conclude that modifying metoprolol dosing based on poor/intermediate metabolizer status was associated significantly with the odds of postoperative AF (odds ratio 0.82, 95% CI 0.15-4.55, p = 0.82).
Conclusions: A CYP2D6 genotype-guided metoprolol management was not associated with a reduction of postoperative AF after cardiac surgery.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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