title: Effect of milrinone on cardiac functions in patients undergoing coronary artery bypass graft: a meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  Inotropes are commonly used to treat myocardial dysfunction, which is the major complication after coronary artery bypass graft (CABG). Milrinone, a phosphodiesterase 3 inhibitor, is one of these inotropes. Recently, a number of clinical studies have been carried out to evaluate the effects of milrinone on cardiac function in patients with low ventricular ejection fraction undergoing CABG. However, it has been inconclusive because of the inconsistent results. In addition, some studies found that milrinone increased the incidence of postoperative atrial arrhythmias and did not show any long-term beneficial effects on survival. Therefore, it is very important to perform a meta-analysis to summarize the results so as to determine the clinical efficacy and safety of milrinone.
  
  
  METHODS
  Several databases and websites for clinical trials were searched until October 2015 for prospective clinical studies comparing milrinone versus placebo on cardiac functions in patients undergoing CAGB.
  
  
  RESULTS
  Four articles were identified by our search strategy. 1) Milrinone decreased incidence of myocardial ischemia and myocardial infarction (15.6% versus 44.4%; 4.7% versus 18% in milrinone and control group, respectively). 2) Milrinone decreased duration of inotropic support (95% confidence interval [CI]: -6.52 to -1.68; P=0.0009) and mechanical ventilation (h) support (95% CI -5.00 to -0.69; P=0.010), but did not decrease the requirement for intra-aortic balloon pump or inotropic support (P>0.05). 3) Milrinone did not decrease the overall mortality or morbidity, intensive care unit stay (P>0.05).
  
  
  CONCLUSIONS
  Perioperative continuous infusion of milrinone is effective to lower incidence of myocardial ischemia and myocardial infarction in patients post-CABG, but it was unable to improve the overall morbidity and mortality or decreased duration of intensive care unit stay. The available sample size is small; therefore, future studies should be directed toward a better understanding of the benefit of milrinone to CABG patients.
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: You
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
authors.forename: Xiaoshu
authors.initials: X
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
authors.forename: Xinghua
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Wu
mesh_terms: D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D020105:Milrinone / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone
keywords: cardiac function; clinical trial; inotropic support; intra-aortic balloon pump; meta-analysis