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Meta-Analysis
. 2018 Jul 11;18(1):143.
doi: 10.1186/s12872-018-0881-6.

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

Tejas P Singh  1   2 , Tristan Skalina  1 , Daniel Nour  1 , Aarya Murali  1 , Sean Morrison  1 , Joseph V Moxon  1 , Jonathan Golledge  3   4
Affiliations
Meta-Analysis

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

Tejas P Singh et al. BMC Cardiovasc Disord. .

Abstract

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.

Keywords: Allopurinol; Atherosclerosis; Myocardial infarction.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable, our manuscript does not contain any individual person’s data.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Outline of the study selection for this systematic review and meta-analysis
Fig. 2
Fig. 2
Forest plot illustrating risk ratios for MI in participants on Allopurinol treatment. Square boxes indicate risk ratios in the primary studies for the risk of MI. The size of the box reflects the statistical weight of the study. Horizontal lines indicate the 95% confidence intervals (CI). The diamond represents the overall risk ratio and 95% CI (RR 0.21, 95% CI 0.06–0.70, p = 0.01), calculated using a fixed effects meta-analysis
See this image and copyright information in PMC

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