This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wijeysundera, D. N. Articles by Beattie, W. S. Search for Related Content PubMed Articles by Wijeysundera, D. N. Articles by Beattie, W. S.

DILTIAZEM REDUCES DEATH AND MYOCARDIAL INFARCTION AFTER NON-CARDIAC SURGERY

Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, Ontario, M5G 2C4

INTRODUCTION

Calcium channel blockers (CCBs) may reduce cardiac complications following non-cardiac surgery. In the non-perioperative setting, CCBs have raised concerns^1,2. We carried out a meta-analysis of all randomized controlled trials (RCTs) evaluating CCBs in non-cardiac surgery.

METHODS

Eligible studies were RCTs comparing CCBs to non-CCBs during non-cardiac surgery and reporting one of the following perioperative outcomes: mortality, myocardial infarction (MI), or myocardial ischemia. Organ transplant recipients, cerebral aneurysm repair, and supraventricular tachyarrythmia treatment were excluded. Studies were retrieved from MEDLINE and EMBASE with no language restriction: (Calcium channel blockers.exp) and (Postoperative complications.exp or Perioperative care.exp or Intraoperative complications.exp). Titles and abstracts were evaluated to exclude ineligible studies. The remaining studies were then read to determine eligibility. Bibliographies were surveyed to identify eligible studies. Study quality was rated using the scale of Jadad et al, a 5-point scale assessing blinding, randomization, and withdrawal documentation. Quality assessment and data abstraction were performed by both authors; disagreements were resolved by consensus. Treatment effects were estimated using odds ratios (OR) and the random effects model (Review Manager 4.1). In the calculation of summary estimates of treatment effects, this model places more emphasis on larger studies with more subjects and outcomes. Subsequently, subgroup analyses were performed for diltiazem, verapamil, and dihydropyridines.

RESULTS

Our search yielded 1813 studies. Eleven studies, encompassing a total of 947 patients, qualified for analysis. The Breslow-Day test for heterogeneity was negative. CCBs reduced myocardial ischemia (OR 0.36, 95% CI 0.13-1.01) and death/MI (OR 0.27, 95% CI 0.09-0.82). In subgroup analyses, diltiazem was associated with significant improvements in ischemia (OR 0.20, 95% CI 0.08-0.51) and death/MI (OR 0.26, 95% CI 0.08-0.87).

DISCUSSION

CCBs cause a significant reduction in perioperative cardiac complications. In subgroup analyses, diltiazem exerted a similar effect independently. An appropriately powered RCT is now justified among patients undergoing non-cardiac surgery.

REFERENCES

1 Circulation 92:1326-31.

2 Hypertension 33:24-31.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wijeysundera, D. N. Articles by Beattie, W. S. Search for Related Content PubMed Articles by Wijeysundera, D. N. Articles by Beattie, W. S.