Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery: The PRESAGE Trial

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Abstract

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.

Original languageEnglish
JournalAnnals of Surgery
DOIs
Publication statusAccepted/In press - Jan 13 2016

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Metoprolol
Losartan
Brain Natriuretic Peptide
Atrial Fibrillation
Lung Neoplasms
Incidence
Confidence Intervals
Control Groups
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

@article{47068a32d89f4a018edf5e9831e19c13,
title = "Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery: The PRESAGE Trial",
abstract = "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.",
author = "Daniela Cardinale and Sandri, {Maria T.} and Alessandro Colombo and Michela Salvatici and Ines Tedeschi and Giulia Bacchiani and Marta Beggiato and Meroni, {Carlo A.} and Maurizio Civelli and Giuseppina Lamantia and Nicola Colombo and Fabrizio Veglia and Monica Casiraghi and Lorenzo Spaggiari and Marco Venturino and Cipolla, {Carlo M.}",
year = "2016",
month = "1",
day = "13",
doi = "10.1097/SLA.0000000000001626",
language = "English",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery

T2 - The PRESAGE Trial

AU - Cardinale, Daniela

AU - Sandri, Maria T.

AU - Colombo, Alessandro

AU - Salvatici, Michela

AU - Tedeschi, Ines

AU - Bacchiani, Giulia

AU - Beggiato, Marta

AU - Meroni, Carlo A.

AU - Civelli, Maurizio

AU - Lamantia, Giuseppina

AU - Colombo, Nicola

AU - Veglia, Fabrizio

AU - Casiraghi, Monica

AU - Spaggiari, Lorenzo

AU - Venturino, Marco

AU - Cipolla, Carlo M.

PY - 2016/1/13

Y1 - 2016/1/13

N2 - 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.

AB - 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.

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U2 - 10.1097/SLA.0000000000001626

DO - 10.1097/SLA.0000000000001626

M3 - Article

AN - SCOPUS:84954357964

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -