Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany; Department of Social Policy, The London School of Economics and Political Science, London, United Kingdom.
Cardiology Department, Al Ahli Hospital, Doha, Qatar; Department of Social Policy, The London School of Economics and Political Science, London, United Kingdom.
Int J Cardiol. 2017 Dec 15;249:127-137. doi: 10.1016/j.ijcard.2017.08.039. Epub 2017 Sep 1.
Atrial fibrillation occurs frequently after open-heart surgery. It is associated with increased morbidity and mortality, longer hospital stays, and increased healthcare costs. Prophylactic administration of colchicine may mitigate post-operative atrial fibrillation (POAF).
We searched PubMed, ClinicalTrials.gov and CENTRAL databases to identify randomized controlled trials (RCTs) that; (1) compared prophylactic use of colchicine to placebo, or usual care, in patients with sinus rhythm who underwent elective open-heart surgery and (2) reported POAF-incidence. We excluded trials focused on incidence of atrial fibrillation after percutaneous interventions or colchicine treatment of diagnosed pericarditis or post-pericardiotomy-syndrome. A random-effects model was used to pool data for POAF-incidence as the primary outcome and for drug-related adverse effects, major adverse events (death and stroke), and hospital length-of-stay as secondary outcomes.
We included five RCTs (1412 patients). Colchicine treatment reduced POAF-events by 30% versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95% confidence interval (CI) 0.57 to 0.84, p=0.0002). Adverse drug-related effects, especially gastrointestinal intolerance, increased with colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p<0.0001). However, major adverse events were unchanged (3.2% vs. 3.2%, RR 0.96, 95% CI 0.48 to 1.95, p=0.92). Length-of-stay decreased by 1.2days with colchicine (95% CI -1.89 to -0.44, p=0.002).
Colchicine demonstrated superior efficacy versus usual care for prevention of atrial fibrillation after cardiac surgery. Moreover, colchicine treatment was associated with shorter hospital stays. These benefits outweigh increased risk of adverse drug-related effects; although further work is needed to minimize gastrointestinal effects.
心脏直视手术后常发生心房颤动。它与发病率和死亡率增加、住院时间延长以及医疗保健费用增加有关。预防性给予秋水仙碱可能减轻术后心房颤动（POAF）。
我们在 PubMed、ClinicalTrials.gov 和 CENTRAL 数据库中搜索了比较秋水仙碱预防使用与安慰剂或常规护理在窦性心律患者中的随机对照试验（RCT），这些患者接受择期心脏直视手术，并报告 POAF 发生率。我们排除了专注于经皮介入后心房颤动发生率或秋水仙碱治疗诊断性心包炎或心包切开术后综合征的试验。我们使用随机效应模型汇总 POAF 发生率作为主要结局，以及药物相关不良反应、主要不良事件（死亡和中风）和住院时间作为次要结局的数据。
我们纳入了 5 项 RCT（1412 名患者）。与安慰剂或常规护理相比，秋水仙碱治疗使 POAF 事件减少了 30%（18% vs. 27%，风险比（RR）0.69，95%置信区间（CI）0.57 至 0.84，p=0.0002）。药物相关不良反应，特别是胃肠道不耐受，随着秋水仙碱的使用而增加；（21% vs. 8.2%，RR 2.52，95% CI 1.62 至 3.93，p<0.0001）。然而，主要不良事件没有改变（3.2% vs. 3.2%，RR 0.96，95% CI 0.48 至 1.95，p=0.92）。与安慰剂相比，秋水仙碱使住院时间缩短 1.2 天（95% CI -1.89 至 -0.44，p=0.002）。
与常规护理相比，秋水仙碱在预防心脏手术后心房颤动方面显示出更好的疗效。此外，秋水仙碱治疗与较短的住院时间相关。这些益处超过了药物相关不良反应风险的增加；尽管需要进一步的工作来最小化胃肠道副作用。
