Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
J Cardiol. 2021 Nov;78(5):349-354. doi: 10.1016/j.jjcc.2021.05.001. Epub 2021 Jun 1.
Perioperative atrial fibrillation (POAF) after non-cardiac surgery is a risk factor for cardiovascular events including stroke and death. The aim of this subanalysis of the MAMACARI study, a multicenter randomized control study on the effectiveness of a bisoprolol transdermal patch for prevention of perioperative myocardial injury in high-risk patients undergoing non-cardiac surgery, was to identify the predictors of POAF after non-cardiac surgery in high-risk patients and to determine changes in blood pressure and heart rate during bisoprolol patch administration in the perioperative period.
Patients aged over 60 years with hypertension and a high revised cardiac risk index (≥2) who were scheduled to undergo non-cardiac surgery were randomly assigned to a bisoprolol patch group (n = 120) or a control group (n = 120). We divided the patients into two groups: patients with POAF (POAF group; n = 16) and patients without POAF (non-POAF group; n = 206). Multivariate analysis showed that bisoprolol patch therapy (OR: 0.30, 95% CI: 0.092-0.978) and surgery time of 250 min or more (OR: 4.99, 95% CI: 1.37-18.2) were independently associated with POAF. Although systolic blood pressure did not differ significantly between the two groups throughout the perioperative period, treatment with a bisoprolol patch significantly reduced heart rate throughout the perioperative period compared with that in the control group.
Low dose of a bisoprolol patch in the perioperative period was effective for prevention of POAF after non-cardiac surgery in high-risk patients, while long surgery time was an independent risk factor for POAF. It is expected that low dose of a bisoprolol patch can prevent POAF without causing hypotension.
非心脏手术后的围手术期心房颤动（POAF）是包括中风和死亡在内的心血管事件的危险因素。本研究是 MAMACARI 研究的一项亚组分析，该研究为一项多中心随机对照研究，旨在评估比索洛尔透皮贴剂预防高危非心脏手术患者围手术期心肌损伤的有效性。本研究的目的是确定高危患者非心脏手术后 POAF 的预测因素，并确定围手术期比索洛尔贴剂给药期间血压和心率的变化。
本研究纳入了年龄超过 60 岁、患有高血压且修订后的心脏风险指数较高（≥2）、拟行非心脏手术的患者，将其随机分为比索洛尔贴剂组（n=120）和对照组（n=120）。我们将患者分为两组：POAF 患者（POAF 组；n=16）和无 POAF 患者（非 POAF 组；n=206）。多变量分析显示，比索洛尔贴剂治疗（OR：0.30，95%CI：0.092-0.978）和手术时间 250min 或更长时间（OR：4.99，95%CI：1.37-18.2）与 POAF 独立相关。尽管整个围手术期两组的收缩压无显著差异，但与对照组相比，比索洛尔贴剂治疗在整个围手术期显著降低了心率。
高危患者围手术期应用小剂量比索洛尔贴剂可有效预防非心脏手术后 POAF 的发生，而手术时间长是 POAF 的独立危险因素。预计小剂量比索洛尔贴剂可预防 POAF 而不引起低血压。
