Key result
Continuation of atorvastatin 40 mg/d in the immediate postoperative period significantly reduced the incidence of post-operative atrial fibrillation compared to no statin (1.5% vs 10.2%, p=0.049).
Why the study?
Postoperative AF occurs in 20% to 40% of patients after CABG, and the study aimed to confirm whether perioperative statins prevent early postoperative AF.
Does continuation of atorvastatin in the early postoperative period reduce the incidence of post-operative atrial fibrillation in patients undergoing isolated CABG?
RCT (n=127)
Randomized
No
Does continuation of atorvastatin in the early postoperative period reduce the incidence of post-operative atrial fibrillation in patients undergoing isolated CABG?
Absolute Event Rate: 1.5% vs 10.2%
p-value: p=0.049
Statin continuation was associated with lower post-CABG AF; hypothesis-generating and requires RCT confirmation before practice change.
Background: Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass grafting (CABG), occurring in 20% to 40% of patients. Statins exert pleiotropic effects which are largely independent from their lipid-lowering properties. The objective of this study was based on to affirm the evidence that perioperative statins have a significant role in preventing early postoperative AF in patients undergoing CABG.Methods: A prospective, randomized, cohort study of all consecutive patients who underwent primary isolated on pump CABG surgery was performed. Patients were divided into two groups -statin and non-statin groups - to examine the influence of statins on early postoperative prevention of AF.Results: In total, 127 patients who underwent isolated CABG were included in the study and were analysed. There were no significant differences in age, gender, history of cardiac infarction, concomitant diseases (hypertension, smoking, PPCI, hyperlipidaemia), cardiac functional grading (NYHA III-IV), electro- cardiograms, and preoperative medication. There were no significant differences in the average number of grafts where the left internal mammary artery was used as a bypass conduit, the surgical procedure or total cardiopulmonary bypass time, or aortic cross-clamping (ACC) time. In addition, there were no significant differences in the postoperative mechanical ventilation duration time, length of ICU stays or length of hospitalization between the two groups. The incidence of AF following CABG in the statin group was significantly lower than that in the non-statin group.Conclusions: Oral atorvastatin 40 mg/d, initiated at least 1 week before the scheduled CABG and continued in the early postoperative period, significantly decreases the risk of post-operative AF.
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Dhaulta et al. (2019) conducted an RCT in Post-operative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) (n=127). Atorvastatin vs. No statin in immediate post-operative period was evaluated on Post-operative atrial fibrillation (POAF) within 5 days after CABG (p=0.049). Continuation of atorvastatin 40 mg/d in the immediate postoperative period significantly reduced the incidence of post-operative atrial fibrillation compared to no statin (1.5% vs 10.2%, p=0.049).
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