Role of Preoperative Atorvastatin Administration in Protection Against Postoperative Atrial Fibrillation Following Conventional Coronary Artery Bypass Grafting

Yifeng Sun; Qiang Ji; Yunqing Mei; Xisheng Wang; Jing Feng; Jianzhi Cai; Liangjie Chi

doi:10.1536/ihj.52.7

January 1, 2011International Heart JournalOpen Access

Role of Preoperative Atorvastatin Administration in Protection Against Postoperative Atrial Fibrillation Following Conventional Coronary Artery Bypass Grafting

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Why the study?

Does preoperative atorvastatin reduce the occurrence of postoperative atrial fibrillation in patients undergoing elective CCABG?

Structured PICO

Does preoperative atorvastatin reduce the occurrence of postoperative atrial fibrillation in patients undergoing elective CCABG?

P

Population

100 consecutive patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass (CCABG), without history of atrial fibrillation or previous statin treatment.

I

Intervention

Atorvastatin 20 mg/d starting 7 days preoperatively

C

Comparator

Placebo starting 7 days preoperatively

O

Outcome

Occurrence of postoperative atrial fibrillationhard clinical

Preoperative atorvastatin administration significantly reduces the incidence of postoperative atrial fibrillation and inflammatory response in patients undergoing elective CABG.

Implication

Supports preoperative atorvastatin to reduce postoperative AF after elective CABG; confirms benefit in this RCT and strengthens perioperative statin evidence.

Abstract

Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (CABG). The aim of this study was to evaluate the effect of preoperative atorvastatin on postoperative atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass (CCABG). One hundred consecutive patients undergoing elective CCABG, without history of AF or previous statin treatment, were enrolled and randomly assigned to a statin group (atorvastatin 20 mg/d, n = 49) or a control group (placebo, n = 51) starting 7 days preoperatively. The primary endpoint was the occurrence of postoperative AF. C-reactive protein (CRP) levels were assessed in all selected patients before surgery and every 24 hours postoperatively until discharge from hospital. Atorvastatin significantly reduced the incidence of postoperative AF and postoperative peak CRP level versus placebo (18% versus 41%, P = 0.017; 129.3 ± 24.3 mg/L versus 149.3 ± 32.5 mg/L, P < 0.0001). Kaplan-Meier curves confirmed a significantly better postoperative atrial fibrillation-free survival in the statin group (χ(2) = 7.466, P = 0.006). Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF (OR = 0.235, P = 0.007), whereas high postoperative CRP levels were associated with increased risk (OR = 2.421, P = 0.015). Preoperative atorvastatin administration may inhibit inflammatory reactions to prevent atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass.