KUOPIO, Finland, April 10 -- Intravenous hydrocortisone after cardiac surgery had a 37% lower relative risk of post-op atrial fibrillation compared with placebo, researchers here reported.
The rate of atrial fibrillation after cardiac surgery, with its increased likelihood of stroke, fell from 48% to 30%, a reduced relative risk of 37%, when 241 patients were randomized to receive 100-mg hydrocortisone or matching placebo on the evening of the operative day, and then one dose every eight hours for three days.
Afib occurrence generally ranges from 20% to 40% after a coronary artery bypass graft and is even higher after valve and combined valve and bypass surgery, Jari Halonen, M.D., of Kuopio University Hospital, and colleagues reported in the April 11 issue of Journal of the American Medical Association.
The findings emerged from a double-blind, placebo-controlled, randomized multicenter trial at three university hospitals in Finland, with patients enrolled from August 2005 to June 2006.
The study included 241 consecutive patients without prior afib or flutter and scheduled to undergo a first on-pump CABG, aortic valve replacement, or combined CABG and valve replacement.
In addition to the hydrocortisone or matching placebo, patients received oral metoprolol (50 to 150 mg/d) titrated to heart rate.
The occurrence of post-op afib during the first 84 hours after surgery was significantly lower in the hydrocortisone group (36/120 [30%] versus 58/121 [48%]; adjusted hazard ratio, 0.54; 95% CI, 0.36-0.82, P<.01, the number needed to treat 5.6). The relative risk reduction was 37%.
http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/tb1/5412
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