Efficacy of atorvastatin in prevention of atrial fibrillation after heart valve surgery in the PROFACE trial (PROphylaxis of postoperative atrial Fibrillation After Cardiac surgEry)

Abstract

BackgroundTo evaluate the efficacy of perioperative atorvastatin administration for prophylaxis of postoperative atrial fibrillation (POAF) after heart valve surgery.MethodsOur study included 90 patients with heart valve disease who were scheduled to undergo elective cardiac surgery. Cases with previous AF or preoperative beta-blocker therapy were excluded. Patients were randomized into the atorvastatin group, which included 47 patients who received 40 mg/day of atorvastatin 7 days before and after the surgery and the control group, which included 43 patients. Primary endpoint was the occurrence of POAF. Secondary endpoints included modifications in the preoperative and postoperative levels of the markers of inflammation (C-reactive protein [CRP]), myocardial injury (ultrasensitive troponin T and creatinine phosphokinase MB [CPK-MB]), and cardiac dysfunction (pro-brain natriuretic peptide [proBNP]) related to POAF and changes in the echocardiographic parameters, such as atrial electromechanical interval, A wave, E/A ratio, and Doppler imaging systolic velocity wave amplitude, related to POAF.ResultsNo relationship between atorvastatin administration and reduction in the incidence of POAF was observed (42.6% in the atorvastatin vs. 30.2% in the control group) (p=0.226). No difference in the levels of CPK-MB, ultrasensitive troponin T, CRP, or proBNP and in the analyzed echocardiographic parameter was detected between both groups.ConclusionsAtorvastatin in the described dose, was not adequate for the prophylaxis of POAF after heart valve surgery. It was ineffective in controlling the inflammatory phenomena, myocardial injury, and echocardiographic predictors of POAF.

Perioperative statin administration with decreased risk of postoperative atrial fibrillation, but not acute kidney injury or myocardial infarction: A meta-analysis

“…Among all 22 studies, 18 trials with 3995 participants reported the outcome of POAF, and nine with 3214 patients reported AKI. 14 RCTs enrolled patients undergoing CABG, three RCTs undergoing valve surgery 13 , 23 , 26 . For studies only involving patients with CABG, five of them were with CPB 17 , 21 , 24 , 25 , 32 , three with off-pump 8 , 17 , 30 , and six with CPB or off-pump 19 , 20 , 22 , 28 , 29 , 33 .…”

(The effect of cardiac venting technique for aortic valve replacement surgery on the incidence of postoperative atrial fibrillation)

“…Rizikové faktory POAF, ktoré nachádzame v literatúre, zahŕňajú elektrické, metabolické, neurohumorálne a zápalové zmeny, ktoré narúšajú geometriu a elektrofyziológiu srdca. 9 Tieto faktory môžeme rozdeliť na faktory spojené s pacientom a faktory spojené s chirurgickou intervenciou (tabuľka 1). 6 Veľa štúdií sa zameriava na vznik POAF po bypassovej operácii srdca, alebo operáciách mitrálnej chlopne.…”

“…Tento výsledok koreluje s prácou autorov Carrascal a spol., ktorí taktiež nepotvrdili vplyv statínov na zníženie incidencie POAF pri izolovanej operácii chlopní. 9 Zväčšenie LA je dôsledok chronického zvýšenia plniacich tlakov v ľavých oddieloch srdca a komorovej diastolickej dysfunkcie. Mosquera a spol.…”

The effect of surgical access for mitral valve surgery on incidence of atrial fibrillation and atrioventricular block

“…V literatúre je uvádzaných viacero liekov ako možná prevencia vzniku pooperačnej AF. Najčastejšie sa uvádzajú -blokátory, Ca-blokátory, vitamín C, sotalol, atorvastatín a amiodaron [3,14,22,23]. Zápalová teória vzniku pooperačnej AF vysvetľuje predoperačné podávanie prednizonu, ako prevenciu AF [14].…”

“…Na druhej strane niektorí autori prezentujú protektívny účinok atorvastatinu len pri bypasovej operácii nie pri operačnom výkone na mitrálnej chlopni. [22,25]. Pozitívny účinok aplikovania vitamínu C na redukciu pooperačnej AF sa však podľa literatúry už pozitívne neprenáša na skrátenie hospitalizácie, alebo celkovo nižšej morbidite [23].…”