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

Ann Surg. 2016 Aug;264(2):244-51. doi: 10.1097/SLA.0000000000001626.

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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / blood
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / prevention & control*
  • Female
  • Humans
  • Incidence
  • Losartan / therapeutic use
  • Lung Neoplasms / blood
  • Lung Neoplasms / surgery*
  • Male
  • Metoprolol / therapeutic use
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Pneumonectomy / adverse effects*
  • Postoperative Complications / blood
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Prospective Studies

Substances

  • Anti-Arrhythmia Agents
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Metoprolol
  • Losartan