1. Dexamethasone for the prevention of postoperative atrial fibrillation
- Author
-
Dirk van Osch, Jan M. Dieleman, Diederik van Dijk, Kirolos A. Jacob, Jolanda Kluin, Pieter A. Doevendans, Hendrik M. Nathoe, Jaap J. Bredée, Wolfgang F. Buhre, Lex A. van Herwerden, Cor J. Kalkman, Jan van Klarenbosch, Karel G. Moons, Sandra C. Numan, Thomas H. Ottens, Kit C. Roes, Anne-Mette C. Sauer, Arjen J. Slooter, Arno P. Nierich, Jacob J. Ennema, Peter M. Rosseel, Nardo J. van der Meer, Joost M. van der Maaten, Vlado Cernak, Jan Hofland, Robert J. van Thiel, Jan C. Diephuis, Ronald M. Schepp, Jo Haenen, Fellery de Lange, Christa Boer, Jan R. de Jong, Jan G. Tijssen, Amsterdam Cardiovascular Sciences, Cardiothoracic Surgery, and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Heart Diseases ,Research Support ,Dexamethasone ,law.invention ,Postoperative Complications ,Randomized controlled trial ,Double-Blind Method ,law ,Atrial Fibrillation ,medicine ,Journal Article ,Corticosteroids ,Humans ,Cardiac Surgical Procedures ,Adverse effect ,Non-U.S. Gov't ,Glucocorticoids ,Postoperative new-onset atrial fibrillation ,Aged ,Netherlands ,Retrospective Studies ,Inflammation ,Dose-Response Relationship, Drug ,business.industry ,Research Support, Non-U.S. Gov't ,Incidence ,Atrial fibrillation ,Perioperative ,Cardiac surgery ,medicine.disease ,Postoperative atrial fibrillation ,Multicenter Study ,Survival Rate ,Treatment Outcome ,Anesthesia ,Relative risk ,Randomized Controlled Trial ,Injections, Intravenous ,Female ,Cardiology and Cardiovascular Medicine ,Complication ,business ,medicine.drug ,Follow-Up Studies - Abstract
Background: Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery. Inflammation is believed to play a pivotal role in the etiology of postoperative AF. There is a suggestion from small studies that perioperative treatment with corticosteroids may reduce postoperative AF. The DExamethasone for Cardiac Surgery (DECS) study was a large randomized trial showing no protective effect of dexamethasone on major adverse events. The aim of this study was to investigate the effect of dexamethasone treatment on the occurrence of AF after cardiac surgery. Methods: The DECS study compared intra-operative dexamethasone (1 mg/kg) or placebo treatment in 4494 adult patients undergoing cardiac surgery. AF was defined by the occurrence of any reported AF within 30 days after surgery. We also performed an in-depth analysis of a subset of 1565 patients on new-onset AF. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Results: The incidence of any AF in the main study of 4494 patients was 33.1% in the dexamethasone and 35.2% in the placebo group (RR 0.94, 95% CI: 0.87-1.02, p = 0.14). In the substudy of 1565 patients, the incidence of new-onset AF was 33.0% vs. 35.5% (RR 0.93, 95% CI: 0.81-1.07, p = 0.31), respectively. There was no protective effect of dexamethasone across clinically important patient subgroups. Conclusion: Intraoperative administration of dexamethasone had no protective effect on the occurrence of any or new-onset atrial fibrillation after cardiac surgery. Therefore, the use of dexamethasone for the reduction of postoperative AF should not be recommended. (C) 2015 Elsevier Ireland Ltd. All rights reserved
- Published
- 2015
- Full Text
- View/download PDF