Abstract
BackgroundAs an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. The aim of this study was to perform a systematic review and meta-analysis of existing studies from the past 20 years to evaluate the impact of milrinone on mortality in patients who undergo CABG surgery.MethodsWe performed a systematic literature search on the application of milrinone in patients who underwent CABG surgery in studies published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included studies evaluated milrinone groups compared to groups receiving either placebo or standard treatment and further compared the systemic administration.ResultsThe network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. In addition, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmia was lower in the milrinone group than in the placebo/standard care group. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, and arrhythmia was significantly different. However, the occurrence of stroke and renal failure, the duration of inotropic support (h), the need for an intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences.ConclusionsBased on the current results, compared with placebo, milrinone might be unable to decrease mortality in adult CABG surgical patients but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia. These results provide evidence for the further clinical application of milrinone and of therapeutic strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient data from randomized clinical trials need to be collected, and the potential benefits and adverse effects should be analyzed and reevaluated.
Highlights
As an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation
coronary artery bypass grafting (CABG) surgery has been reported to be associated with low costs, superior outcomes, and short-term mortality [13,14,15,16], multiple complications, such as myocardial infarction (MI), myocardial ischemia, arrhythmia, stroke, and acute renal failure (ARF), are impossible to ignore and are still concerning to researchers and clinical doctors [7, 17,18,19,20], To minimize the occurrence of postoperative complications, pre- and/or postoperative medicinal applications, such as phosphodiesterase (PDE) III inhibitors, have been the primary strategies to date [21,22,23]
The inclusion criteria were as follows: patients randomly allocated according to treatment, groups receiving milrinone compared with groups receiving placebo/standard care with no restrictions in terms of dose or time of administration, CABG surgery performed in adult patients, and information provided on primary outcomes
Summary
Milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. Coronary artery bypass grafting (CABG) surgery is the primary strategy for CAD treatment [5,6,7,8,9]. CABG surgery has been reported to be associated with low costs, superior outcomes, and short-term mortality [13,14,15,16], multiple complications, such as MI, myocardial ischemia, arrhythmia, stroke, and acute renal failure (ARF), are impossible to ignore and are still concerning to researchers and clinical doctors [7, 17,18,19,20], To minimize the occurrence of postoperative complications, pre- and/or postoperative medicinal applications, such as phosphodiesterase (PDE) III inhibitors, have been the primary strategies to date [21,22,23]
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