Calcium antagonists reduce cardiovascular complications after cardiac surgery: a meta-analysis.
OBJECTIVE
We sought to determine the efficacy of calcium antagonists (CAs) in reducing death, myocardial infarction (MI), ischemia, and supraventricular tachyarrhythmia (SVT) after cardiac surgery.


BACKGROUND
Calcium antagonists may reduce complications after cardiac surgery-namely, death, MI, and renal failure. However, they are underused, possibly due to the results from previous observational studies.


METHODS
Both MEDLINE (1966 to December 2001) and EMBASE (1980 to December 2001) were searched, with supplementation by reference list searches. No language restrictions were applied. Included studies were randomized, controlled trials (RCTs) evaluating preoperative, intraoperative, or postoperative (first 48 h) CA use (intravenous or oral) during aortocoronary bypass or valve surgery. Studies were excluded if they exclusively recruited transplant recipients, individuals <18 years old, or patients with pre-existing SVT. Two reviewers independently evaluated study quality by using the Jadad score; a minimal score of 1/5 was required. Forty-one studies, encompassing 3,327 patients, were included. No studies assessed treatment exclusively with short-acting oral nifedipine. Treatment effects were calculated using the random-effects model. Heterogeneity was assessed using the Q test.


RESULTS
Calcium antagonists significantly reduced MI (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.91; p = 0.02) and ischemia (OR 0.53, 95% CI 0.39 to 0.72; p < 0.001). Non-dihydropyridines significantly reduced SVT (OR 0.62, 95% CI 0.41 to 0.93; p = 0.02). Calcium antagonists were associated with trends toward decreased mortality during aortocoronary bypass (OR 0.66, 95% CI 0.26 to 1.70, p = 0.4).


CONCLUSIONS
Use of CAs during cardiac surgery significantly reduced rates of MI, ischemia, and SVT. Further study using large RCTs is justified.
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Duminda N
DN
Wijeysundera
W Scott
WS
Beattie
Vivek
V
Rao
Jacek
J
Karski
D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D017202:Myocardial Ischemia / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D013617:Tachycardia, Supraventricular / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*
D002121:Calcium Channel Blockers