Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting

Dinicolantonio, James J., Beavers, Craig J., Menezes, Arthur R., Lavie, Carl J., O'Keefe, James H., Meier, Pascal, Vorobcsuk, András, Aradi, Dániel, Komocsi, András, Chatterjee, Saurav, D'Ascenzo, Fabrizio, Gasparini, Mauro, Brugts, Jasper and Biondi-Zoccai, Giuseppe (2014) Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting. American Journal of Cardiology, 113 3: 565-569. doi:10.1016/j.amjcard.2013.10.020


Author Dinicolantonio, James J.
Beavers, Craig J.
Menezes, Arthur R.
Lavie, Carl J.
O'Keefe, James H.
Meier, Pascal
Vorobcsuk, András
Aradi, Dániel
Komocsi, András
Chatterjee, Saurav
D'Ascenzo, Fabrizio
Gasparini, Mauro
Brugts, Jasper
Biondi-Zoccai, Giuseppe
Title Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting
Formatted title
Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting
Journal name American Journal of Cardiology   Check publisher's open access policy
ISSN 0002-9149
1879-1913
Publication date 2014-02-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.amjcard.2013.10.020
Volume 113
Issue 3
Start page 565
End page 569
Total pages 5
Place of publication Bridgewater, United States
Publisher Excerpta Medica
Language eng
Formatted abstract
A systematic review and meta-analysis was performed to evaluate the effects of carvedilol versus metoprolol on the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and Excepta Medica (EMBASE) were searched up to March 2013 for suitable randomized controlled trials. Data were pooled using random-effects model for pairwise analyses. A total of 4 trials with 601 patients were included in this analysis. Pairwise analyses showed that compared with metoprolol, carvedilol significantly reduced the incidence of postoperative atrial fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In conclusion, compared with metoprolol, carvedilol significantly reduces the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

Although many approaches have been attempted to prevent postoperative atrial fibrillation, current guidelines suggest β blockers as first-line medication to prevent postoperative atrial fibrillation after coronary artery bypass graft.1 and 2 However, pharmacologic characteristics differ considerably between β blockers. Carvedilol is a unique β blocker, exerting vasodilating, antioxidant, and free-radical scavenging effects. Although metoprolol preferentially inhibits cardiac β1 receptors as opposed to β2 receptors, carvedilol inhibits postsynaptic cardiac β1, β2, and α1 receptors and presynaptic β2 receptors, upregulates cardiac muscarinic M2 receptors, and evokes antioxidant effects, properties that are not shared by atenolol, metoprolol, or bisoprolol.3, 4 and 5 Thus, we sought to perform a systematic review and meta-analysis of randomized controlled trials to determine if carvedilol reduces the incidence of postoperative atrial fibrillation compared with metoprolol in patients undergoing coronary artery bypass grafting.

Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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