Role of Preoperative Atorvastatin Administration in Protection Against Postoperative Atrial Fibrillation Following Conventional Coronary Artery Bypass Grafting

Abstract

SummaryAtrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (CABG). The aim of this study was to evaluate the effect of preoperative atorvastatin on postoperative atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass (CCABG). One hundred consecutive patients undergoing elective CCABG, without history of AF or previous statin treatment, were enrolled and randomly assigned to a statin group (atorvastatin 20 mg/d, n = 49) or a control group (placebo, n = 51) starting 7 days preoperatively. The primary endpoint was the occurrence of postoperative AF. C-reactive protein (CRP) levels were assessed in all selected patients before surgery and every 24 hours postoperatively until discharge from hospital. Atorvastatin significantly reduced the incidence of postoperative AF and postoperative peak CRP level versus placebo (18% versus 41%, P = 0.017; 129.3 ± 24.3 mg/L versus 149.3 ± 32.5 mg/L, P < 0.0001). Kaplan-Meier curves confirmed a significantly better postoperative atrial fibrillation-free survival in the statin group (χ 2 = 7.466, P = 0.006). Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF (OR = 0.235, P = 0.007), whereas high postoperative CRP levels were associated with increased risk (OR = 2.421, P = 0.015). Preoperative atorvastatin administration may inhibit inflammatory reactions to prevent atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass. (Int Heart J 2011; 52: 7-11) Key words: Coronary artery bypass grafting, Cardiopulmonary bypass, Atorvastatin, Atrial fibrillation A trial fibrillation (AF) is one of the most important complications after coronary artery bypass grafting (CABG) and has an incidence of approximately 30%.1,2) Atrial fibrillation can severely influence hemodynamic stability; it can induce loss of atrial pump function resulting in impairment of ventricular filling with a decrease in cardiac output and an increase in incidence of stroke, thus contributing to the rise of postoperative disability and mortality.3) For patients with atrial fibrillation, especially in those after CABG, a rapid ventricular rate significantly increases myocardial oxygen consumption, induces cardiac insufficiency, and aggravates myocardial ischemia; it can even lead to tachycardiomyopathy, which can severely threaten the life of the patient. Therefore, it is very important to prevent atrial fibrillation following CABG. Recent studies found that atrial fibrillation after CABG may be associated with inflammatory response, and statins have been shown to inhibit such inflammatory response, and reduce the incidence of AF after CABG. [4][5][6][7][8] Nevertheless, since atrial fibrillation has a significant genetic heterogeneity and the effects of the drugs used to treat the latter are different among different races, exploring the effects of statins on postoperative...

The statin therapy to prevent atrial fibrillation after cardiac surgery: Shakespearean dilemma

“…However, these recommendations are based on randomized trials that were small and had other important limitations. An updated meta-analysis of the results from previously published randomized trials of perioperative statin therapy (15)(16)(17)(18) showed an approximate halving of the incidence of postoperative AF with statins as compared with placebo. However, those trials involved small numbers of patients and had other important limitations.…”

“…However, those trials involved small numbers of patients and had other important limitations. For example, only same of the trials were designed with a prespecified postoperative AF as an outcome (16,29,30), and only one trial (29) included an intention-to-treat analysis of the effect on AF as detected in a systematic and blinded manner. Furthermore, a recent systematic Cochrane review of those trials showed evidence of selective reporting and publication bias (31).…”

“…The concentration of C-reactive protein after statin therapy, decrease in some studies (15)(16)(17). Perioperative statin therapy has been associated with a lower incidence of AF after cardiac surgery, as well as less severe myocardial injury preserved left ventricular and renal function, and shorter stays in the intensive care unit (ICU) and hospital (18).…”

Pre-operative use of anti-aggregants may reduce atrial fibrillation development rate during coronary bypass surgery

“…Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (1). This complication leads to increases in mortality and morbidity rate in coronary bypass surgery and in hospital stay caused by excess usage of medications (2).…”

“…Açık cerrahi yöntem ile karşılaştırıldığında endovasküler yöntemin üstünlükleri, preoperatif kan kaybının az olması, çoğu zaman epidural anestezi altında uygulanabilmesi, hastanede kalış süresinin kısa olması ve daha düşük mortalite ve morbidite ile seyretmesi olarak sıralanabilir (1,2). Özellikle, yüksek risk taşıyan hastalarda, düşük mortalite ve morbidite ile seyrettiği gözlenmektedir (3).…”