A meta-analysis of the efficacy of allopurinol in reducing the incidence of myocardial infarction following coronary artery bypass grafting

Singh, Tejas P., Skallina, Tristan, Nour, Daniel, Murali, Aarya, Morrison, Sean, Moxon, Joseph V., and Golledge, Jonathan (2018) A meta-analysis of the efficacy of allopurinol in reducing the incidence of myocardial infarction following coronary artery bypass grafting. BMC Cardiovascular Disorders, 18.

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Background: The xanthine oxidase inhibitor allopurinol that is commonly used to treat gout, has been suggested to have pleiotropic effects that are likely to reduce the incidence of myocardial infarction (MI) in at risk individuals. The aim of this meta-analysis was to assess the efficacy of allopurinol treatment in reducing the incidence of MI.

Method: MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched for randomised controlled trials examining the efficacy of allopurinol in reducing the incidence of MI. The quality of study methodology was assessed by two independent reviewers using the Cochrane Collaboration’s tool for assessing risk of bias. This meta-analysis was conducted using a fixed-effects model, and heterogeneity was assessed with the I2 index.

Results: One thousand one hundred twenty-three citations were screened and only six studies satisfied the inclusion criterion. Published between 1988 and 1995, all studies examined the cardioprotective efficacy of allopurinol in the setting of coronary artery bypass graft (CABG). From a total pooled sample size of 229, MI was reported in 2 (1.77%) allopurinol and 14 (12.07%) control patients. A fixed-effects meta-analysis (I2 = 0%) identified a statistically significant reduced incidence of myocardial infarction (RR 0.21, 95% CI: 0.06, 0.70, p = 0.01) in patients allocated to allopurinol. However, in the leave-one-out sensitivity analyses, the treatment effect became non-significant with the removal of one of the studies.

Conclusion: Based on the limited evidence available, allopurinol appears to reduce the incidence of perioperative MI following CABG. Further research is required to confirm these findings.

Item ID: 56851
Item Type: Article (Research - C1)
ISSN: 1471-2261
Keywords: myocardial infarction, allopurinol, atherosclorosis
Copyright Information: © The Author(s) 2018 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Funders: National Health and Medical Research Council (NHMRC), Office of Health and Medical Research (OHMR), Queensland Government (QG)
Projects and Grants: NHMRC practitioner fellowship 1117061, OHMR Senior Clinical Research, QG Advance Queensland Mid-Career Fellowship, QG Junior Doctor Research Fellowship
Date Deposited: 15 Jan 2019 05:27
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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