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A prospective randomized trial to determine the effects of steroid on the incidence of postoperative atrial fibrillation after coronary artery bypass grafting surgery (CABG) Prasongsukarn, Kriengchai
Abstract
Background Atrial fibrillation remains one of the most common postoperative complications of coronary artery bypass grafting (CABG). Because of the additional hospital costs associated with this arrhythmia, owing to increased use of antiarrhythmic medications, diagnostic studies, and prolonged hospitalization, this subject continues to draw the interest of cardiac surgeons and cardiologists. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for this arrhythmia. There are several mechanisms that explain why atrial fibrillation occurs after CABG, still the pathophysiological mechanism remains unclear, and therefore mutifactorial causes are likely. One of the mechanisms that we believe is inflammation around the sac of the heart and surgical trauma, including the generalized inflammation response induced by the heart-lung machine. As we know, steroid can decrease the body's response to trauma and inflammation and may reduce the chance of atrial fibrillation occurring. For this reason we design the study to assess the short-term effect of steroid on the incidence of postoperative atrial fibrillation after CABG. Methods This study was done during the time from August 2000 to February 2001 .Eighty-eight consecutive consenting patients were prospectively entered into a randomized, double blind, placebo-controlled trial to determine the efficacy of steroid on the incidence of atrial fibrillation after elective coronary artery bypass grafting. No patient had documented or suspected arrhythmias preoperatively. Two patients were excluded from the study due to Off-PumpCABG, forty-three patients received 1 gm of methyprednisolone before surgery and 4 mg of dexamethasone every 6 hours for one day after surgery, and forty-three patients received only placebo. Results Postoperative atrial fibrillation occurred in 9 of the 43 patients in the steroid group (21 percent) and 22 of the 43 patients in the placebo group (51 percent) (p=0.003). Minor postoperative complications occurred in 15 steroid patients (34 percent) and in 6 patients receiving placebo (14 percent). Major complications occurred in 4 patients who received steroid (9 percent) and in 2 who received placebo (5 percent) (p=0.052) Patients with atrial fibrillation were hospitalized for significantly longer days than were patients with normal sinus rhythm (median 8Vs.6 days, p=0.002); however, the length of hospital stay in Steroid group was 6 days compare with 7 days in Placebo group (p=0.337). Conclusions The use of prophylactic Short-Term Steroid Administration in patients undergoing coronary bypass grafting surgery reduced the incidence of postoperative atrial fibrillation by approximately 50 percent. Patients without postoperative atrial fibrillation had a shorter length of hospital stay. Overall, there was no significant difference between Steroid Group and Placebo Group with regard to the length of hospital stay. In this study, we found that Steroid had higher complications which may contribute to prolonged hospitalization.
Item Metadata
Title |
A prospective randomized trial to determine the effects of steroid on the incidence of postoperative atrial fibrillation after coronary artery bypass grafting surgery (CABG)
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Creator | |
Publisher |
University of British Columbia
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Date Issued |
2002
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Description |
Background
Atrial fibrillation remains one of the most common postoperative
complications of coronary artery bypass grafting (CABG). Because of the
additional hospital costs associated with this arrhythmia, owing to increased use of
antiarrhythmic medications, diagnostic studies, and prolonged hospitalization, this
subject continues to draw the interest of cardiac surgeons and cardiologists. Despite
many clinical studies, there is still no consensus regarding the best prevention
strategy for this arrhythmia. There are several mechanisms that explain why atrial
fibrillation occurs after CABG, still the pathophysiological mechanism remains
unclear, and therefore mutifactorial causes are likely. One of the mechanisms that
we believe is inflammation around the sac of the heart and surgical trauma,
including the generalized inflammation response induced by the heart-lung
machine. As we know, steroid can decrease the body's response to trauma and
inflammation and may reduce the chance of atrial fibrillation occurring. For this
reason we design the study to assess the short-term effect of steroid on the
incidence of postoperative atrial fibrillation after CABG.
Methods
This study was done during the time from August 2000 to February
2001 .Eighty-eight consecutive consenting patients were prospectively entered into
a randomized, double blind, placebo-controlled trial to determine the efficacy of
steroid on the incidence of atrial fibrillation after elective coronary artery bypass
grafting. No patient had documented or suspected arrhythmias preoperatively. Two
patients were excluded from the study due to Off-PumpCABG, forty-three patients
received 1 gm of methyprednisolone before surgery and 4 mg of dexamethasone
every 6 hours for one day after surgery, and forty-three patients received only
placebo.
Results
Postoperative atrial fibrillation occurred in 9 of the 43 patients in the steroid
group (21 percent) and 22 of the 43 patients in the placebo group (51 percent)
(p=0.003). Minor postoperative complications occurred in 15 steroid patients (34
percent) and in 6 patients receiving placebo (14 percent). Major complications
occurred in 4 patients who received steroid (9 percent) and in 2 who received
placebo (5 percent) (p=0.052) Patients with atrial fibrillation were hospitalized for
significantly longer days than were patients with normal sinus rhythm (median
8Vs.6 days, p=0.002); however, the length of hospital stay in Steroid group was 6
days compare with 7 days in Placebo group (p=0.337).
Conclusions
The use of prophylactic Short-Term Steroid Administration in patients
undergoing coronary bypass grafting surgery reduced the incidence of
postoperative atrial fibrillation by approximately 50 percent. Patients without
postoperative atrial fibrillation had a shorter length of hospital stay. Overall,
there was no significant difference between Steroid Group and Placebo Group
with regard to the length of hospital stay. In this study, we found that Steroid
had higher complications which may contribute to prolonged hospitalization.
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Extent |
4044179 bytes
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Genre | |
Type | |
File Format |
application/pdf
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Language |
eng
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Date Available |
2009-08-14
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Provider |
Vancouver : University of British Columbia Library
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Rights |
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.
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DOI |
10.14288/1.0090248
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URI | |
Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
2002-05
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Campus | |
Scholarly Level |
Graduate
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Aggregated Source Repository |
DSpace
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Item Citations and Data
Rights
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.