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STICS: Statin therapy did not reduce complications after cardiac surgery

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BARCELONA, Spain — High-dose statin treatment just before and after cardiac surgery did not reduce the rate of postoperative in-hospital complications, according to findings from the STICS trial.

“Previous small randomized trials had suggested that postoperative statin therapy might halve the likelihood of developing atrial fibrillation after cardiac surgery, as well as preventing damage to the heart muscle and kidney failure,” investigator Barbara Casadei, MD, DPhil, said in a press release. “We expected there to be beneficial results in STICS, [which was] twice as big as all the previous trials combined and involved particularly careful and systematic assessment of postoperative complications. Despite this, we found no evidence of benefit from perioperative statin therapy.”

Casadei, from the John Radcliffe Hospital at the University of Oxford, and colleagues randomly assigned 1,922 patients in sinus rhythm awaiting elective cardiac surgery to 20 mg daily rosuvastatin (Crestor, AstraZeneca) or placebo. Treatment began up to 8 days before surgery and continued for up to 5 days afterward.

The researchers performed a systematic assessment of effects on AF via 5-day Holter ECG and myocardial injury via troponin assays. The primary outcomes were new-onset AF and changes in troponin I serum levels.

At 48 hours after surgery, those assigned rosuvastatin had a 25% reduction in cholesterol compared with those assigned placebo (P<.0001), according to the researchers.

Despite that, there was no difference between the groups in new-onset AF (statin group, 21%; placebo group, 20%; OR=1.04; 95% CI, 0.84-1.3) or cardiac muscle injury as indicated by troponin I levels (difference in mean areas under the curve, 2%; 95% CI, –8 to 14), Casadei said during a press conference at ESC Congress.

There was no difference in new-onset AF among prespecified subgroups, and no benefit from rosuvastatin was observed for secondary outcomes, including length of stay, major in-hospital cardiac or cerebrovascular events, left ventricular function as indicated by ECG or plasma creatinine, according to the researchers.

“Intensive perioperative treatment with rosuvastatin has no beneficial effects on postoperative AF, heart muscle damage or other complications after cardiac surgery,” Casadei said at the press conference. “Preoperative statin use, type of surgery, postoperative use of anti-inflammatory drugs and time of initiation of randomized treatment had no bearing on the results.”

For more information:

Casadei B. Hot Line V. Coronary Artery Disease and Atrial Fibrillation. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Disclosure: The study was funded by the British Heart Foundation, The European Network for Translational Research in Atrial Fibrillation, the Oxford Biomedical Research Centre, the UK Medical Research Council and an unrestricted grant from AstraZeneca. Casadei reports that her institution received the grant from AstraZeneca.