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Preoperative statin therapy may help reduce AF after surgery
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Participants who received statin therapy before cardiac surgery experienced a reduction in postoperative atrial fibrillation and a shortened stay in the ICU and in the hospital.
A team of researchers in Germany searched for randomized controlled trials in major trial databases comparing patients who received any statin treatment before cardiac surgery for any given duration and dose with patients who received no preoperative statin therapy or placebo. Eleven trials with mean study duration of 16 months and 984 participants (28.5% women) undergoing on- or off-pump cardiac surgery procedures were included in the analysis.
According to pooled analysis, incidence of postoperative AF was reduced when participants received statin pretreatment before surgery (OR=0.4; 95% CI, 0.29-0.55). However, short-term mortality (OR=0.98; 95% CI, 0.14-7.10) or postoperative stroke (OR=0.7; 95% CI, 0.14-3.63) were not influenced.
In addition, participants in the statin therapy group were released earlier from the ICU (weighted mean difference=–3.39 hours; 95% CI, –5.77 to –1.01) and in-hospital (weighted mean difference=–0.48 days; 95% CI, –0.85 to –0.11) vs. the control group. Study results showed no reduction in MI (OR=0.52; 95% CI, 0.2-1.3) or renal failure (OR=0.41; 95% CI, 0.15-1.12).
MI occurred in 1.3% of participants in the statin group and 2.7% in the control group. When compared with the overall result, a subgroup analysis of studies showed the treatment effect of statin on MI in the on-pump CABG subgroup was accentuated (OR=0.39; 95% CI, 0.14-1.12). In contrast, a reduction of statin treatment effect for MI was revealed in a pooled analysis (OR=0.85; 95% CI, 0.29-2.74). In the statin group, 1.1% of participants experienced stroke vs. 1.6% in the control group. Renal failure was experienced in 3.2% of participants on statins vs. 7.1% in the control group.
“In light of an increasing proportion of patients referred to cardiac surgery presenting with multiple comorbidities that potentially precipitate the development of adverse outcomes after surgery, the pre-treatment with statins needs to be investigated in these high-risk patient cohorts,” the researchers concluded. “Moreover, studies comparing the different types of statins and dose regimens before and after surgery are highly desirable since new statin agents have emerged that may or may not offer further or more beneficial effects.”
Disclosure: The researchers report no relevant financial disclosures.
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