Statins for prevention of atrial fibrillation after cardiac surgery: A systematic literature review

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 138; no. 3; pp. 678 - 686.e1
• Main Authors: Liakopoulos, Oliver J., MD, Choi, Yeong-Hoon, MD, Kuhn, Elmar W., MD, Wittwer, Thorsten, MD, Borys, Michal, MD, Madershahian, Navid, MD, Wassmer, Gernot, PhD, Wahlers, Thorsten, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2009; AATS/WTSA; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Heart; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Male; Medical sciences; Odds Ratio; Pneumology; Reproducibility of Results; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; 23; RCT; 35; ACE; OR; AF; 16; odds ratio; randomized controlled trial; atrial fibrillation; CABG; angiotensin-converting enzyme; coronary artery bypass grafting; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Statin derivative; Cardiac surgery; Excitability disorder; Prevention; Heart disease; Anesthesia; Circulatory system; Cardiology; Bibliographic review; Antilipemic agent
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.03.054

Objective To determine the strength of evidence of preoperative statin therapy for prevention of atrial fibrillation after cardiac surgery. Methods A meta-analysis was performed of randomized controlled trials and observational trials reporting the impact of preoperative statin therapy on the incidence of any type and new-onset atrial fibrillation after cardiac surgery. Unadjusted and adjusted treatment effects (odds ratio, 95% confidence intervals) were pooled using a random-effects model, and publication bias was assessed. Results Thirteen studies were identified (3 randomized controlled trials, 10 observational trials) that reported the incidence of postoperative atrial fibrillation in 17,643 patients having cardiac surgery with (n = 10,304; 58%) or without (n = 7339; 42%) preoperative statin use. New-onset atrial fibrillation was reported in a total of 7855 patients. Postoperative incidence rates for any or new-onset atrial fibrillation were 24.6% and 29.9%, respectively. Preoperative statin use resulted in a 22% and 34% unadjusted odds reduction for any atrial fibrillation (odds ratio, 0.78; 95% confidence interval, 0.67–0.90) or new-onset atrial fibrillation (odds ratio, 0.66; 95% confidence interval, 0.51–0.84) after surgery ( P < .001). Relevant publication bias and an unequal distribution of confounding variables favoring patients treated with statins were identified. Nevertheless, the beneficial actions of statins on atrial fibrillation persisted after pooled analysis of risk-adjusted treatment effects from randomized controlled trials and observational trials (any atrial fibrillation—odds ratio, 0.64; 95% confidence interval, 0.48–0.87; new-onset atrial fibrillation—odds ratio, 0.66; 95% confidence intervals, 0.48–0.89; P < .01). Conclusion Our meta-analysis provides evidence that preoperative statin therapy is associated with a reduction in the incidence of atrial fibrillation after cardiac surgery.