Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery: The PRESAGE Trial
| Autor: | Carlo Ambrogio Meroni, Alessandro Colombo, Fabrizio Veglia, Michela Salvatici, Marco Venturino, Giuseppina Lamantia, Giulia Bacchiani, Daniela Cardinale, Maurizio Civelli, Ines Tedeschi, Maria Teresa Sandri, Marta Beggiato, Carlo M. Cipolla, Lorenzo Spaggiari, Monica Casiraghi, Nicola Colombo |
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| Přispěvatelé: | Cardinale, Daniela, Sandri, Maria T, Colombo, Alessandro, Salvatici, Michela, Tedeschi, Ine, Bacchiani, Giulia, Beggiato, Marta, Meroni, Carlo A, Civelli, Maurizio, Lamantia, Giuseppina, Colombo, Nicola, Veglia, Fabrizio, Casiraghi, Monica, Spaggiari, Lorenzo, Venturino, Marco, Cipolla, Carlo M |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Lung Neoplasms medicine.medical_treatment 030204 cardiovascular system & hematology Losartan 03 medical and health sciences Pneumonectomy 0302 clinical medicine Postoperative Complications Peptide Fragment Internal medicine Atrial Fibrillation Natriuretic Peptide Brain medicine Humans 030212 general & internal medicine cardiovascular diseases Prospective Studies Prospective cohort study Metoprolol Aged Lung cancer surgery business.industry Incidence Atrial fibrillation Perioperative Middle Aged medicine.disease Peptide Fragments Lung Neoplasm Anti-Arrhythmia Agent Relative risk Anesthesia Cardiology Surgery Female Postoperative Complication business Anti-Arrhythmia Agents hormones hormone substitutes and hormone antagonists medicine.drug circulatory and respiratory physiology Human |
| Popis: | OBJECTIVE We performed a prospective, randomized clinical study to assess whether prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, reduces the incidence of postoperative atrial fibrillation. BACKGROUND Postoperative atrial fibrillation is a well recognized complication after lung cancer surgery, with an incidence as high as 30%. Perioperative increase of NT-proBNP has been demonstrated to be a strong independent predictor of postoperative atrial fibrillation in this setting. METHODS NT-proBNP concentration was measured 24 hours before surgery and soon after surgery in 1116 patients. Three hundred twenty (29%) patients showed a high NT-proBNP value and were enrolled: 108 were assigned to the metoprolol group, 102 to the losartan group, and 110 to the control group. RESULTS Overall, the incidence of postoperative atrial fibrillation was 20% (n = 64); it was significantly lower in the metoprolol and losartan groups compared with the control group [6%, 12%, and 40%, respectively; relative risk 0.19, 95% confidence intervals (CIs), 0.09-0.37; P < 0.001 in the metoprolol group; and 0.29, 95% CI, 0.16-0.52; P < 0.001 in the losartan group). No significant difference was found when the metoprolol and losartan groups were directly compared (P = 0.21). CONCLUSIONS A prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with high NT-proBNP levels, significantly reduced the occurrence of postoperative atrial fibrillation. |
| Databáze: | OpenAIRE |
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