A systematic review and meta-analysis published in BMC Cardiovascular Disorders found that glucocorticoids reduce postoperative atrial fibrillation (POAF) risk, especially when administered in a low dose and to patients who have received coronary artery bypass graft (CABG).
Investigators from the Chongqing Traditional Chinese Medicine University searched publication databases through December 2021 for randomized controlled trials evaluating post-surgical POAF prevention strategies.
A total of 27 articles were included in this analysis. The studies were conducted primarily in the European Union, North America, and Asia and the most recent study was published in 2016.
The pooled study population comprised 14,442 patients who had received CABG or valvular surgeries. The active interventions included dexamethasone, methylprednisolone, and hydrocortisone.
Risk for POAF was decreased more with glucocorticoid therapy (relative risk [RR], 0.80; 95% CI, 0.71-0.92; P =.001) compared with the control group.
In a subgroup analysis, low-dose (<100 mg) dexamethasone significantly reduced POAF risk (RR, 0.81; 95% CI, 0.71-0.92; I2, 59.3%; P =.001) whereas high-dose (³100 mg) dexamethasone did not (RR, 0.81; 95% CI, 0.56-1.19; I2, 69.8%; P =.286). Glucocorticoid therapy reduced POAF risk in patients who received CABG only (RR, 0.71; 95% CI, 0.58-0.87; I2, 26.3%; P =.001).
Glucocorticoid use was not associated with infection risk (RR, 0.85; 95% CI, 0.68-1.06; I2, 38.3%; P =.158) or gastrointestinal injury (RR, 1.12; 95% CI, 0.83-1.50; I2, 0.0%; P =.450).
The limitations of this analysis include the pooling of corticosteroid treatments, the observed heterogeneity, and the lack of recent large studies.
“The results of this study showed that glucocorticoids were beneficial in reducing the effect of POAF, and low-dose glucocorticoids could reduce the incidence of POAF,” the study authors wrote. “However, heterogeneity of overall study and subgroup analysis was high, so we held a cautious recommendation. Our study also did not find that glucocorticoids use increased the risk of infection and gastrointestinal injury.”
Zhou Z, Long Y, He X, Li Y. Effects of different doses of glucocorticoids on postoperative atrial fibrillation: a meta‑analysis. BMC Cardiovasc Disord. Published online January 12, 2023. doi:10.1186/s12872-022-03001-0