title: Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery: The PRESAGE Trial.
abstract: OBJECTIVE
  We performed a prospective, randomized clinical study to assess whether prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, reduces the incidence of postoperative atrial fibrillation.
  
  
  BACKGROUND
  Postoperative atrial fibrillation is a well recognized complication after lung cancer surgery, with an incidence as high as 30%. Perioperative increase of NT-proBNP has been demonstrated to be a strong independent predictor of postoperative atrial fibrillation in this setting.
  
  
  METHODS
  NT-proBNP concentration was measured 24 hours before surgery and soon after surgery in 1116 patients. Three hundred twenty (29%) patients showed a high NT-proBNP value and were enrolled: 108 were assigned to the metoprolol group, 102 to the losartan group, and 110 to the control group.
  
  
  RESULTS
  Overall, the incidence of postoperative atrial fibrillation was 20% (n = 64); it was significantly lower in the metoprolol and losartan groups compared with the control group [6%, 12%, and 40%, respectively; relative risk 0.19, 95% confidence intervals (CIs), 0.09-0.37; P < 0.001 in the metoprolol group; and 0.29, 95% CI, 0.16-0.52; P < 0.001 in the losartan group). No significant difference was found when the metoprolol and losartan groups were directly compared (P = 0.21).
  
  
  CONCLUSIONS
  A prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with high NT-proBNP levels, significantly reduced the occurrence of postoperative atrial fibrillation.
authors.affiliation: *Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy†Laboratory Medicine Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy.‡Cardiology Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy.§Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Milan, Italy.||Department of Thoracic Surgery, European Institute of Oncology, I.R.C.C.S., Milan, Italy.¶Department of Thoracic Surgery, European Institute of Oncology, I.R.C.C.S., University of Milan School of Medicine, Milan, Italy.**Department of Anaesthesiology, European Institute of Oncology, I.R.C.C.S., Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cardinale
authors.forename: Maria T
authors.initials: MT
authors.lastname: Sandri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Colombo
authors.forename: Michela
authors.initials: M
authors.lastname: Salvatici
authors.forename: Ines
authors.initials: I
authors.lastname: Tedeschi
authors.forename: Giulia
authors.initials: G
authors.lastname: Bacchiani
authors.forename: Marta
authors.initials: M
authors.lastname: Beggiato
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Meroni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Civelli
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Lamantia
authors.forename: Nicola
authors.initials: N
authors.lastname: Colombo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Monica
authors.initials: M
authors.lastname: Casiraghi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.forename: Marco
authors.initials: M
authors.lastname: Venturino
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Cipolla
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D019808:Losartan / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000097:blood / Q000601:surgery*; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D008790:Metoprolol; D019808:Losartan