Impact of statin treatment on postoperative atrial fibrillation in surgical aortic valve replacement

BACKGROUND: Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, associated with significant risk of long-term complications. The aim is to investigate the impact of statin treatment on the risk of POAF, and the association of POAF with mortality in patients undergoing surgical aortic valve replacement (SAVR). METHODS: This population-based observational study was conducted from January 2016 to April 2022, with follow-up data until April 2024. We included all patients undergoing isolated SAVR with bioprosthetic valve in Western Denmark. Propensity score (PS) matching was employed to create comparable groups, and multivariable Cox regression models to analyze cumulative statin dose-response effect. RESULTS: A total of 1,475 patients undergoing SAVR were included in the study, with a median follow-up of 4.9 years (IQR: 3.1-6.4 years). Among these, 789 patients were statin treated, while 686 were untreated. After PS matching, 493 pairs of patients were identified. In the PS population (history of atrial fibrillation excluded), the adjusted odds ratio (aOR) for POAF was 1.15 (95% CI 0.86-1.54). POAF was associated with a significant risk of new-onset atrial fibrillation (aOR 19.4, 95% CI 11.9-31.6), but not with all-cause mortality after adjustment (aHR 1.37, 95% CI 0.98-1.92). High cumulative statin doses were associated with a significant reduction in mortality (HR 0.89, 95% CI 0.81-0.97). CONCLUSIONS: Statin treatment was not associated with reduced risk of POAF following SAVR. POAF was associated with a significant risk of new-onset atrial fibrillation, but not mortality after adjusting for confounders. High cumulative statin doses were significantly associated with a reduced all-cause mortality.