Protective effects of corticosteroids in coronary artery bypass graft surgery alone or combined with valvular surgery: an updated and comprehensive meta-analysis and systematic review.
This systematic review with meta-analysis sought to determine the protective effects of corticosteroids on clinical outcomes following coronary artery bypass grafting (CABG). Medline, Embase, Elsevier and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The effect sizes measured were odds ratio (OR) for categorical variables and weighted mean difference with 95% confidence interval (CI) for calculating differences between mean values of duration of hospitalization in intervention and control groups. Values of P < 0.1 for Q-test or I(2) > 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 3735 studies. After screening, a total of 45 trials were identified that reported outcomes. Pooled analysis was performed on incidence of atrial fibrillation (OR of 0.71; 95% CI: 0.59-0.86; P = 0.000), stroke (OR of 1.61; 95% CI: 0.63-4.1; P = 0.3), infection (OR of 1.03; 95% CI: 0.68-1.5; P = 0.8), re-infarction (OR of 0.88; 95% CI: 0.47-1.63; P = 0.6), length of ventilation time [weighted mean difference (WMD) of 0.257; 95% CI: 0.10-0.41; P = 0.00], length of hospital stay (WMD of -0.48; 95% CI: -0.66 to -0.3; P = 0.000), amount of blood loss (WMD of -124.05; 95% CI: -147.72 to -100.38; P = 0.00), re-exploration (OR of 1.25; 95% CI: 0.66-2.35; P = 0.4) and mortality (OR of 0.87; 95% CI: 0.46-1.64; P = 0.6). Overall, steroid prophylaxis in patients undergoing CABG could significantly reduce complications such as atrial fibrillation and length of hospital stay, but slightly increased the length of ventilation time. On the other hand, no significant impact on the incidence of infection was observed compared with the placebo.
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran s.alihassan.cardiosurg@gmail.com sadegh_sayegh@yahoo.com.
Sadegh
S
Ali-Hassan-Sayegh
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Department of Cardiovascular Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Seyed Jalil
SJ
Mirhosseini
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Fatemeh
F
Haddad
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Ali Akbar
AA
Karimi-Bondarabadi
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Arezoo
A
Shahidzadeh
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Alexander
A
Weymann
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Aron-Frederik
AF
Popov
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Anton
A
Sabashnikov
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D065840:Protective Factors; D012086:Reoperation; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones
Atrial fibrillation; Cardiopulmonary bypass; Clinical outcome; Complication; Coronary artery bypass graft