Preoperative Statin Therapy for Atrial Fibrillation and Renal Failure after Cardiac Surgery

Abstract

Background Performing cardiac surgery in patients with cardiovascular risk factors incorporates a steady risk for the development of postoperative complications. Perioperative statin intake was associated with an improvement of perioperative outcomes in these patients. However, the European Association for Cardio-Thoracic Surgery guidelines regarding the perioperative statin treatment were changed recently due to large studies reporting about relevant adverse effects related to statin therapy.

Methods All relevant databases were searched including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the metaRegister of Controlled Trials. Various registries were screened (National Research Register, the ClinicalTrials.gov, and gray literature) with search on online conference indices of relevant scientific meetings. No language restrictions were applied.

Results We identified 10 randomized controlled studies summarizing 3,468 participants undergoing various kinds of cardiac surgical procedures. All included studies presented with marked differences regarding study design. Pooled analysis indicated that statin pretreatment was associated with a formally reduced incidence of postoperative atrial fibrillation (AF) (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.39–1.00; p = 0.05) but with an increased incidence of renal failure (OR 1.20, 95% CI 1.01–1.44; p = 0.04) compared with control. Substantial heterogeneity was observed among studies reporting about AF.

Conclusion Current but sparse evidence reveals that statin pretreatment is associated with a higher rate of postoperative renal failure compared with control therapy but is ineffective to substantially reduce postoperative AF. Given the relevant heterogeneity among included studies, statin pretreatment cannot be generally recommended.

Keywords

cardiac surgery - statin therapy - adverse outcomes - systematic review - meta-analysis

Publication History

Received: 22 June 2019

Accepted: 16 March 2020

Article published online:
07 June 2020

• References

• 1 Beckmann A, Funkat AK, Lewandowski J. et al. German Heart Surgery Report 2015: the annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2016; 64 (06) 462-474
• 2 Alexander JH, Emery Jr RW, Carrier M. et al; MEND-CABG II Investigators. Efficacy and safety of pyridoxal 5′-phosphate (MC-1) in high-risk patients undergoing coronary artery bypass graft surgery: the MEND-CABG II randomized clinical trial. JAMA 2008; 299 (15) 1777-1787
• 3 Brugts JJ, Yetgin T, Hoeks SE. et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009; 338: b2376
• 4 Kuhn EW, Slottosch I, Wahlers T, Liakopoulos OJ. Preoperative statin therapy for patients undergoing cardiac surgery. Cochrane Database Syst Rev 2015; (08) CD008493
• 5 Billings IV FT, Hendricks PA, Schildcrout JS. et al. High-dose perioperative atorvastatin and acute kidney injury following cardiac surgery: a randomized clinical trial. JAMA 2016; 315 (09) 877-888
• 6 Zheng Z, Jayaram R, Jiang L. et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med 2016; 374 (18) 1744-1753
• 7 Sousa-Uva M, Head SJ, Milojevic M. et al. 2017 EACTS guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg 2018; 53 (01) 5-33
• 8 Cleophas TJ, Zwinderman AH. Meta-analysis. Circulation 2007; 115 (22) 2870-2875
• 9 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7 (03) 177-188
• 10 Almansob MA, Xu B, Zhou L. et al. Simvastatin reduces myocardial injury undergoing noncoronary artery cardiac surgery: a randomized controlled trial. Arterioscler Thromb Vasc Biol 2012; 32 (09) 2304-2313
• 11 Baran Ç, Durdu S, Dalva K. et al. Effects of preoperative short term use of atorvastatin on endothelial progenitor cells after coronary surgery: a randomized, controlled trial. Stem Cell Rev Rep 2012; 8 (03) 963-971
• 12 Dehghani MR, Kasianzadeh M, Rezaei Y, Sepehrvand N. Atorvastatin reduces the incidence of postoperative atrial fibrillation in statin-naive patients undergoing isolated heart valve surgery: a double-blind, placebo-controlled randomized trial. J Cardiovasc Pharmacol Ther 2015; 20 (05) 465-472
• 13 Mannacio VA, Iorio D, De Amicis V, Di Lello F, Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial. J Thorac Cardiovasc Surg 2008; 136 (06) 1541-1548
• 14 Park JH, Shim JK, Song JW, Soh S, Kwak YL. Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Med 2016; 42 (09) 1398-1407
• 15 Prowle JR, Calzavacca P, Licari E. et al. Pilot double-blind, randomized controlled trial of short-term atorvastatin for prevention of acute kidney injury after cardiac surgery. Nephrology (Carlton) 2012; 17 (03) 215-224
• 16 Song YB, On YK, Kim JH. et al. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. Am Heart J 2008; 156 (02) 373.e9-373.e16
• 17 Vukovic PM, Maravic-Stojkovic VR, Peric MS. et al. Steroids and statins: an old and a new anti-inflammatory strategy compared. Perfusion 2011; 26 (01) 31-37
• 18 Winchester DE, Wen X, Xie L, Bavry AA. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol 2010; 56 (14) 1099-1109
• 19 Liakopoulos OJ, Choi YH, Haldenwang PL. et al. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients. Eur Heart J 2008; 29 (12) 1548-1559
• 20 Liakopoulos OJ, Choi YH, Kuhn EW. et al. Statins for prevention of atrial fibrillation after cardiac surgery: a systematic literature review. J Thorac Cardiovasc Surg 2009; 138 (03) 678-686.e1