Statin pretreatment and risk of in-hospital atrial fibrillation among patients undergoing cardiac surgery: a collaborative meta-analysis of 11 randomized controlled trials

Patti, Giuseppe; Bennett, R. L.; Seshasai, Sreenivasa Rao Kondapally; Cannon, Christopher P.; Cavallari, Ilaria; Chello, Massimo; Nusca, Annunziata; Mega, Simona; Caorsi, Carlos E.; Spadaccio, Cristiano; On, Young Keun; Mannacio, Vito; Berkan, Öcal; Yilmaz, Mehmet Birhan; Katrancioglu, Nurkay; Ji, Qiang; Kourliouros, Antonios; Baran, Çağdaş; Pasceri, Vincenzo; Akar, Ahmet; Kaski, Juan Carlos; Sciascio, Germano Di; Ray, Kausik K.

doi:10.1093/europace/euv001

Cited by 26 publications

(10 citation statements)

References 57 publications

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“…Current meta-analysis shares the similar results with the previous systematic review and meta-analyses 7 , 37 – 40 , and the recent ones are summarized in Table 3 . Though consistent, the current meta-analysis generally concurs and further extends the finding of previous meta-analysis in several important ways.…”

Section: Discussionsupporting

confidence: 80%

“…of trials Primary Outcome Secondary outcomes Chemical indexes Main results (OR/RR) Patti et al . 7 11 RCTs POAF Myocardial injury, MACE, mortality, stroke CRP POAF: 0.41 (0.31 to 0.54) Putzu et al . 37 23 RCTs (including cross-over trial) AKI, POAF, MI, stroke, infection Mortality NR POAF: 0.80 (0.70 to 0.91) AKI: 1.18 (0.99 to 1.41) Rezaei et al .…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies, randomized controlled trials (RCTs), and meta-analysis have demonstrated that perioperative statin use could decrease the incidence of POAF and AKI 7 – 10 , and latest guidelines suggested statins should be administrated in all patients undergoing coronary artery bypass graft (CABG) except for specific contradictions 11 . However, recent studies fail to verify the beneficial effect of statin use in cardiac surgery, and the controversy still exists 12 – 16 .…”

Section: Introductionmentioning

confidence: 99%

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

Shi

Chen

et al. 2017

Sci Rep

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A controversy effect of perioperative statin use for preventing postoperative atrial fibrillation (POAF) and acute kidney injury (AKI) after cardiac surgery still remains. We thus performed current systematic review and meta-analysis to comprehensively evaluate effects of statin in cardiac surgery. 22 RCTs involving 5243 patients were included. Meta-analysis of 18 randomized controlled trials with 3995 participants suggested that perioperative statin use could decrease the risk of POAF (relative risk [RR] 0.69, 95%CI 0.56 to 0.86, P = 0.001), with a moderate heterogeneity (I 2 = 65.7%, P H < 0.001). And the beneficial effect was found only in patients receiving coronary artery bypass graft (CABG), but not in patients undergoing valve surgery. However, perioperative statin use was not associated with lower risks of AKI (RR 0.98, 95%CI 0.70 to 1.35, P = 0.884, I 2 = 33.9%, P H = 0.157) or myocardial infarction (MI) (RR 0.84, 95%CI 0.58 to 1.23, P = 0.380, I 2 = 0%, P H = 0.765), and even an increased trend of AKI was observed in patients with valve surgery. Perioperative statin use could decrease the inflammation response with no impact on clinical outcomes. In conclusion, perioperative statin use is useful in preventing POAF, particularly in patients with CABG, and ameliorate inflammation, while it has no effect on AKI and MI after cardiac surgery.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Shi

Chen

et al. 2017

Sci Rep

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“…Although it is not a life-threatening rhythm disturbance and may present as self-limiting onset, it has major medical and economical implications ( 22 ). The pathogenesis of AF after cardiac surgery is believed to be multifactorial, including clinical variables and technical intraoperative factors ( 30 , 31 ). The present study was aimed to determine the relationship between incidence of AF and duration of CPB pump in patients after coronary artery bypass graft surgery.…”

Section: Discussionmentioning

confidence: 99%

Association between incidence of atrial fibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery (CABG): a cohort study

Rajabi¹,

Safarpoor²,

Borzou³

et al. 2018

Electron Physician

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BackgroundOpen heart surgery is one of the most common and valuable treatment methods for cardiovascular diseases, a common side effect of which is atrial fibrillation that occurs due to various reasons.ObjectiveTo determine the relationship between incidence of atrial fibrillation (AF) and duration of cardiopulmonary bypass (CPB) in patients after open heart surgery.MethodsThe present retrospective cohort study was conducted on 330 patients in Farshchian Heart Center through census. The required data were collected from medical records of the patients undergoing coronary bypass surgery using data collection between April 2015 and March 2015. Then, data analysis was performed using SPSS software (ver.16) at error level of p<0.05. The tests used in this study included independent-samples t-test, Mann-Whitney, and chi-squared tests.ResultsBased on the results, mean age of the patients was 61.76±9.2, the majority of the patients (70.1%) were male. The association between Incidence of Atrial Fibrillation and cardiopulmonary pump time (minute) was not meaningful. Incidence of atrial fibrillation had statistically significant relationship with variables of mean age, BMI, PAC, PVC, creatinine and duration of hospitalization (p<0.05); on the other hand, variables of gender, cross clamp time (minute), intubation time (hour), and clinical history had no effect on atrial fibrillation incidence rate (p>0.05).ConclusionSince the pathogenesis of AF after cardiac surgery is believed to be multifactorial, including clinical variables and technical intraoperative factors, the relation between incidence of AF with mean age, BMI, PAC, PVC, creatinine and duration of hospitalization was significant. But AF was not related to cardiopulmonary pump time (minute). It is necessary to conduct further research on factors affecting incidence of atrial fibrillation.

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“…The available research data leave no doubt in the presence of anti-infl ammatory and anti-arrhythmic effects of statins [35]. The meta-analysis of 15 clinical studies confi rmed the important role of using statins in patients prior to CABG and demonstrated the infl uence of statins on the decrease of POAF frequency in the early postoperative period.…”

Section: Resultsmentioning

confidence: 85%

Statin therapy in the prevention of atrial fibrillation in the early postoperative period after coronary artery bypass grafting: A meta-analysis

et al. 2017

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Pooperační fi brilace síní (postoperative atrial fibrillation, POAF) se v časném pooperačním období vyskytuje přibližně u třetiny pacientů po aortokoronárním bypassu (CABG). Patogeneze POAF je multifaktoriální a dosud nebyla důkladně zkoumána. Řada studií se jako na možný základní faktor POAF zaměřila převážně na pooperační zánětlivou odpověď. Je známo, že statiny působí protizánětlivě. Několik studií prokázalo sníženou incidenci POAF po CABG v případech, kdy byly v předoperačním a perioperačním období podávány statiny. Cíl: Provedli jsme metaanalýzu randomizovaných a observačních studií účinnosti podávání statinů v prevenci POAF po CABG. Materiál a metody: Do metaanalýzy byly zařazeny údaje 15 klinických studií s celkem 9 369 pacienty, u nichž byl v posledních deseti letech proveden CABG. Z tohoto počtu jich 5 598 (59,75 %) statiny užívalo a 3 771 pacientů (40,25 %) nebyly statiny podávány. Mezi parametry hodnocené v časném pooperačním období patřily incidence POAF, celková mortalita, celková incidence cévních mozkových příhod a celková incidence infarktu myokardu. Zaznamenávaly se i délka hospitalizace a hodnoty zánětlivých markerů před a po CABG. Výsledky: Léčba statiny snížila incidenci POAF po CABG (OR = 0,48; 95% CI 0,35-0,67; p < 0,001). Podávání statinů zkrátilo i celkovou délku hospitalizace a snížilo hodnoty zánětlivých markerů v séru. Závěr: Výsledky naší metaanalýzy prokázaly nade vši pochybnost protizánětlivý a antiarytmický účinek statinů. Potvrzujeme celkově pozitivní úlohu podávání statinů před CABG jako prevenci vzniku POAF.

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Statin pretreatment and risk of in-hospital atrial fibrillation among patients undergoing cardiac surgery: a collaborative meta-analysis of 11 randomized controlled trials

Abstract: Short-term statin pretreatment may reduce the risk of postoperative AF among patients undergoing cardiac surgery.

Cited by 26 publications

References 57 publications

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

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

Association between incidence of atrial fibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery (CABG): a cohort study

Statin therapy in the prevention of atrial fibrillation in the early postoperative period after coronary artery bypass grafting: A meta-analysis

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