Ruffin Richard T, Kluger Jeffrey, Baker William L, Wills Stephanie M, White C Michael, Coleman Craig I
University of Connecticut Schools of Pharmacy and Medicine, Storrs and Farmington, CT 06269, USA.
Curr Med Res Opin. 2008 Apr;24(4):1131-6. doi: 10.1185/030079908x280671. Epub 2008 Mar 10.
Nonsteroidal anti-inflammatory drug (NSAID) use may reduce the incidence of post-cardiothoracic surgery (CTS) atrial fibrillation (AF). The cerebrovascular and cardiovascular safety of using NSAIDs for post-CTS AF has not been determined.
To evaluate whether NSAIDs could reduce the incidence of post-CTS atrial fibrillation without increasing patients' risk of stroke or myocardial infarction (MI).
Patients (n = 555) undergoing CTS from the Atrial Fibrillation Suppression Trials I, II and III were evaluated in this nested cohort study. Demographic, surgical and medication use characteristics were prospectively collected as part of the AFIST trials. Endpoints included post-CTS atrial fibrillation, stroke, MI and the need for red blood cell transfusion. Multivariable logistic regression was used to control for potential confounders and calculate adjusted odds ratios with 95% confidence intervals.
The population was 67.8 +/- 8.6 years old and 77.1% male with 127 (22.9%) patients receiving an NSAID postoperatively. Overall, 14.6% underwent valve surgery, 6.1% had prior AF, 12.6% had heart failure and 84.0% and 44.1% received postoperative beta-blockade and prophylactic amiodarone. NSAID use was associated with reductions in the adjusted odds of post-CTS atrial fibrillation (0.54 (0.32-0.90)) and the need for RBC transfusions (0.63 (0.41-0.97)). No elevation in the odds of developing stroke (1.10 (0.21-5.66)) or MI (1.70 (0.40-7.10)) was observed.
Patients were not randomized to receive NSAIDs versus a control. We may not have had adequate power to evaluate stoke or MI in this analysis.
NSAIDs decreased the odds of developing post-CTS atrial fibrillation, further supporting the hypothesis of inflammation as a trigger for post-CTS atrial fibrillation. The need for RBC transfusions was also reduced with NSAID use. We may have been underpowered to evaluate stroke or MI incidence, but the qualitative elevations in these variables suggest more safety data is needed before NSAIDs can be routinely recommended.
使用非甾体抗炎药（NSAID）可能降低心胸外科手术后（CTS）房颤（AF）的发生率。使用NSAIDs预防CTS后房颤的脑血管和心血管安全性尚未确定。
评估NSAIDs是否能降低CTS后房颤的发生率，同时不增加患者中风或心肌梗死（MI）的风险。
在这项巢式队列研究中，对来自房颤抑制试验I、II和III的接受CTS的患者（n = 555）进行了评估。作为AFIST试验的一部分，前瞻性收集了人口统计学、手术和用药特征。终点包括CTS后房颤、中风、MI以及红细胞输血需求。采用多变量逻辑回归来控制潜在的混杂因素，并计算调整后的比值比及95%置信区间。
研究人群的年龄为67.8±8.6岁，男性占77.1%，127名（22.9%）患者术后接受了NSAID治疗。总体而言，14.6%的患者接受了瓣膜手术，6.1%的患者既往有房颤，12.6%的患者有心力衰竭，84.0%和44.1%的患者术后接受了β受体阻滞剂和预防性胺碘酮治疗。使用NSAIDs与CTS后房颤的调整后发生率降低（0.54（0.32 - 0.90））以及红细胞输血需求降低（0.63（0.41 - 0.97））相关。未观察到中风（1.10（0.21 - 5.66））或MI（1.70（0.40 - 7.10））发生率的升高。
患者未随机分组接受NSAIDs或对照治疗。在本分析中，我们可能没有足够的检验效能来评估中风或MI。
NSAIDs降低了CTS后房颤的发生率，进一步支持了炎症是CTS后房颤触发因素的假说。使用NSAIDs也减少了红细胞输血需求。我们评估中风或MI发生率的检验效能可能不足，但这些变量的定性升高表明，在NSAIDs能够被常规推荐之前，还需要更多的安全性数据。
