AI Article Synopsis
- The study aimed to test if using a patient’s CYP2D6 genotype to guide metoprolol dosing could lower the risk of developing postoperative atrial fibrillation (AF) after cardiac surgery.
- The trial involved 73 cardiac surgery patients, who were categorized based on their CYP2D6 metabolizer status to inform medication dosing.
- Results showed that 30% of the patients developed postoperative AF, and there was no significant evidence that adjusting metoprolol based on metabolizer status effectively reduced this risk.
Article Abstract
Objectives: To test the hypothesis that implementation of a cytochrome P-450 2D6 (CYP2D6) genotype-guided perioperative metoprolol administration will reduce the risk of postoperative atrial fibrillation (AF), the authors conducted the Preemptive Pharmacogenetic-Guided Metoprolol Management for Atrial Fibrillation in Cardiac Surgery pilot study.
Design: Clinical pilot trial.
Setting: Single academic center.
Participants: Seventy-three cardiac surgery patients.
Measurements And Main Results: Patients were classified as normal, intermediate, poor, or ultrarapid metabolizers after testing for their CYP2D6 genotype. A clinical decision support tool in the electronic health record advised providers on CYP2D6 genotype-guided metoprolol dosing. Using historical data, the Bayesian method was used to compare the incidence of postoperative AF in patients with altered metabolizer status to the reference incidence. A logistic regression analysis was performed to study the association between the metabolizer status and postoperative AF while controlling for the Multicenter Study of Perioperative Ischemia AF Risk Index. Of the 73 patients, 30% (n = 22) developed postoperative AF; 89% (n = 65) were normal metabolizers; 11% (n = 8) were poor/intermediate metabolizers; and there were no ultrarapid metabolizer patients identified. The estimated rate of postoperative AF in patients with altered metabolizer status was 30% (95% CI 8%-60%), compared with the historical reference incidence (27%). In the risk-adjusted analysis, there was insufficient evidence to conclude that modifying metoprolol dosing based on poor/intermediate metabolizer status was associated significantly with the odds of postoperative AF (odds ratio 0.82, 95% CI 0.15-4.55, p = 0.82).
Conclusions: A CYP2D6 genotype-guided metoprolol management was not associated with a reduction of postoperative AF after cardiac surgery.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1053/j.jvca.2023.06.017 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!