Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

Abstract

Background-Atrial fibrillation (AF) after cardiac surgery is associated with increased risk of complications, length of stay, and cost of care. Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF. We tested this observation in a randomized, controlled trial. Methods and Results-Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass, without previous statin treatment or history of AF, were enrolled. Patients were randomized to atorvastatin (40 mg/d, nϭ101) or placebo (nϭ99) starting 7 days before operation. The primary end point was incidence of postoperative AF; secondary end points were length of stay, 30-day major adverse cardiac and cerebrovascular events, and postoperative C-reactive protein (CRP) variations. Atorvastatin significantly reduced the incidence of AF versus placebo (35% versus 57%, Pϭ0.003). Accordingly, length of stay was longer in the placebo versus atorvastatin arm (6.9Ϯ1.4 versus 6.3Ϯ1.2 days, Pϭ0.001). Peak CRP levels were lower in patients without AF (Pϭ0.01), irrespective of randomization assignment. Multivariable analysis showed that atorvastatin treatment conferred a 61% reduction in risk of AF (odds ratio 0.39, 95% confidence interval 0.18 to 0.85, Pϭ0.017), whereas high postoperative CRP levels were associated with increased risk (odds ratio 2.0, 95% confidence interval 1.2 to 7.0, Pϭ0.01). The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms. Conclusions-Treatment with atorvastatin 40 mg/d, initiated 7 days before surgery, significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay. These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery.

Guidelines on myocardial revascularization

“…Two RCTs evaluating the effect of statin pre-treatment suggested effectiveness in preventing post-operative AF, possibly through anti-inflammatory effects (OR 0.57, 95% CI 0.42 0.77) [187,188]. Table 31 summarizes the recommendations concerning the prevention and treatment of atrial fibrillation in CABG patients.…”

Statins Reduce Short‐ and Long‐Term Mortality Associated With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: Impact of Postoperative Atrial Fibrillation and Statin Therapy on Survival

“…13 The beneficial effect of statins is believed to be partly related to their pleiotropic properties that could attenuate postoperative inflammatory response. 14 Given that postoperative inflammatory response is a key mechanism of the genesis of POAF, 14 -17 the impact of statin therapy on survival might differ in patients with or without POAF.…”

Uso crônico e regular de estatina previne fibrilação atrial no pós-operatório de cirurgia cardíaca

“…The use of statins to prevent atrial fibrillation after cardiac surgery was described in the study ARMYDA-3 (Atorvastatin for Reduction of Myocardial Dysrhythmias After Cardiac Surgery), in which the administration of atorvastatin was started on the seventh day before the surgery, demonstrating a significant reduction in the incidence of atrial fibrillation 4 . This study, which used atorvastatin at high doses and for a short period of time, significantly reduced not only the incidence of atrial fibrillation (p = 0.017, CI = 95%, 0.18 to 0.85, OR = 0.39), but also the length of hospital stay (p = 0.001).…”

“…Atrial arrhythmias are frequent complications in the period after cardiac surgery, affecting from 11 to 40% of patients who undergo myocardial revascularization and 50% of patients who undergo valve replacement Atrial fibrillation is a common arrhythmia in the period after cardiac surgery, which prolongs the use of mechanical ventilation and vasoactive drugs, causing an increase in morbidity and hospitalization time, thereby overloading the health service [3][4][5] . Its pathogenesis is linked to variables such as: age, previous atrial arrhythmia, left ventricular end-diastolic pressure, intraoperative technical factors and inflammatory mechanisms 4,6,7 .…”

“…Its pathogenesis is linked to variables such as: age, previous atrial arrhythmia, left ventricular end-diastolic pressure, intraoperative technical factors and inflammatory mechanisms 4,6,7 .…”