肺癌手术高危患者心房颤动的预防：PRESAGE试验
Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery: The PRESAGE Trial.
作者信息
Cardinale Daniela, Sandri Maria T, Colombo Alessandro, Salvatici Michela, Tedeschi Ines, Bacchiani Giulia, Beggiato Marta, Meroni Carlo A, Civelli Maurizio, Lamantia Giuseppina, Colombo Nicola, Veglia Fabrizio, Casiraghi Monica, Spaggiari Lorenzo, Venturino Marco, Cipolla Carlo M
机构信息
*Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy†Laboratory Medicine Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy.‡Cardiology Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy.§Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Milan, Italy.||Department of Thoracic Surgery, European Institute of Oncology, I.R.C.C.S., Milan, Italy.¶Department of Thoracic Surgery, European Institute of Oncology, I.R.C.C.S., University of Milan School of Medicine, Milan, Italy.**Department of Anaesthesiology, European Institute of Oncology, I.R.C.C.S., Milan, Italy.
出版信息
Ann Surg. 2016 Aug;264(2):244-51. doi: 10.1097/SLA.0000000000001626.
OBJECTIVE
We performed a prospective, randomized clinical study to assess whether prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, reduces the incidence of postoperative atrial fibrillation.
BACKGROUND
Postoperative atrial fibrillation is a well recognized complication after lung cancer surgery, with an incidence as high as 30%. Perioperative increase of NT-proBNP has been demonstrated to be a strong independent predictor of postoperative atrial fibrillation in this setting.
METHODS
NT-proBNP concentration was measured 24 hours before surgery and soon after surgery in 1116 patients. Three hundred twenty (29%) patients showed a high NT-proBNP value and were enrolled: 108 were assigned to the metoprolol group, 102 to the losartan group, and 110 to the control group.
RESULTS
Overall, the incidence of postoperative atrial fibrillation was 20% (n = 64); it was significantly lower in the metoprolol and losartan groups compared with the control group [6%, 12%, and 40%, respectively; relative risk 0.19, 95% confidence intervals (CIs), 0.09-0.37; P < 0.001 in the metoprolol group; and 0.29, 95% CI, 0.16-0.52; P < 0.001 in the losartan group). No significant difference was found when the metoprolol and losartan groups were directly compared (P = 0.21).
CONCLUSIONS
A prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with high NT-proBNP levels, significantly reduced the occurrence of postoperative atrial fibrillation.
目的
我们进行了一项前瞻性随机临床研究，以评估在肺癌手术后不久，对N末端脑钠肽前体（NT-proBNP）水平升高的患者使用美托洛尔或氯沙坦进行预防性治疗是否能降低术后房颤的发生率。
背景
术后房颤是肺癌手术后一种公认的并发症，发生率高达30%。围手术期NT-proBNP升高已被证明是这种情况下术后房颤的一个强有力的独立预测因素。
方法
对1116例患者在手术前24小时和手术后不久测量NT-proBNP浓度。320例（29%）患者NT-proBNP值较高并被纳入研究：108例被分配到美托洛尔组，102例被分配到氯沙坦组，110例被分配到对照组。
结果
总体而言，术后房颤的发生率为20%（n = 64）；美托洛尔组和氯沙坦组的发生率显著低于对照组[分别为6%、12%和40%；相对风险0.19，95%置信区间（CI），0.09 - 0.37；美托洛尔组P < 0.001；以及0.29，95% CI，0.16 - 0.52；氯沙坦组P < 0.001]。美托洛尔组和氯沙坦组直接比较时未发现显著差异（P = 0.21）。
结论
在肺癌手术后不久，对NT-proBNP水平高的患者使用美托洛尔或氯沙坦进行预防性治疗，可显著降低术后房颤的发生。
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