Perioperative use of cardiac medical therapy among patients undergoing coronary artery bypass graft surgery: a systematic review.
Perioperative use of cardiac medical therapy among patients undergoing coronary artery bypass graft surgery: a systematic review.
复制标题
接受冠状动脉搭桥手术的患者围术期心脏药物治疗的使用：系统评价。
DOI：
10.1016/j.ahj.2007.04.036
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发表时间：
2007
影响因子：
4.8
通讯作者：
M. Eisenberg
中科院分区：
文献类型：
--
作者：
K. Filion;L. Pilote;E. Rahme;M. Eisenberg
背景：围术期心脏药物治疗在冠状动脉搭桥术患者中的应用尚未被仔细研究。目的：本研究的目的是系统地回顾有关围术期心脏药物治疗对冠状动脉搭桥术患者临床结局的影响的医学文献。方法：利用Medline数据库和在线临床试验数据库，我们回顾了所有随机对照试验(RCT)和观察性研究，这些研究考察了围术期血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体阻滞剂、抗脂剂(包括他汀类药物)、阿司匹林、β阻滞剂和钙通道阻滞剂对临床结果的影响。结果综述确定了27篇研究(6篇RCT，21篇观察性研究)，涉及：700000例患者，研究围手术期药物治疗对冠状动脉旁路移植术后临床结局的影响。尽管研究提供了相互矛盾的结果，但文献表明，围手术期使用阿司匹林可以降低住院死亡率和心肌梗死，而围手术期使用血管紧张素转换酶抑制剂似乎没有好处。围术期应用他汀类药物可降低冠状动脉搭桥术后30天的全因死亡率和60天及1年的心源性死亡，但似乎不能降低心肌梗死或充血性心力衰竭的发生率。多项研究表明，β受体阻滞剂治疗前后与房颤的减少有关。此外，β阻滞剂可以降低住院和30天的死亡率，尽管这些结果在所有研究中并不一致。钙通道阻滞剂似乎不能改善住院或30天内的死亡率。CABG患者围手术期应用血管紧张素II受体阻滞剂或非他汀类抗脂药的情况尚无研究。结论CABG患者围手术期心脏内科治疗的应用尚不清楚。考虑到它们在心血管疾病患者中已被证实的益处，以及它们改善CABG患者预后的潜力，需要进一步的研究，特别是大型随机对照试验。
BACKGROUNDThe use of perioperative cardiac medical therapy among patients undergoing coronary artery bypass graft surgery (CABG) has not been closely examined.OBJECTIVESThe objective of this study was to systematically review the medical literature examining the effects of perioperative cardiac medical therapy on clinical outcomes among patients undergoing CABG.METHODSUsing the Medline database and online clinical trial databases, we reviewed all randomized controlled trials (RCTs) and observational studies examining the effect of perioperative angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, antilipid agents (including statins), aspirin, β-blockers, and calcium-channel blockers on clinical outcomes.RESULTSOur review identified 27 studies (6 RCTs, 21 observational studies), involving >700000 patients, that examined the impact of perioperative medical therapy on clinical outcomes after CABG. Although studies provide conflicting results, the literature suggests that perioperative aspirin use may decrease inhospital mortality and myocardial infarction, whereas perioperative angiotensin-converting enzyme inhibitor use does not appear to be beneficial. Perioperative statin use reduces all-cause mortality at 30 days and cardiac death at 60 days and 1 year post-CABG but does not appear to reduce myocardial infarction or congestive heart failure rates. Multiple studies have demonstrated that pre- and postoperative β-blockers are associated with a decrease in atrial fibrillation. In addition, β-blockers may reduce inhospital and 30-day mortality, although these results are not consistent across all studies. Calcium-channel blockers do not appear to improve inhospital or 30-day mortality. No studies examined the perioperative use of angiotensin II receptor blockers or nonstatin antilipid agents among CABG patients.CONCLUSIONSThe perioperative use of cardiac medical therapy among CABG patients remains understudied. Given their proven benefits among patients with cardiovascular disease and their potential to improve outcomes among CABG patients, further studies, particularly large RCTs, are needed.