Effect of Preoperative Atorvastatin Therapy on Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Grafting

• Published in: Circulation Journal Vol. 73; no. 12; pp. 2244 - 2249
• Main Authors: Ji, Qiang, Mei, Yunqing, Wang, Xisheng, Sun, Yifeng, Feng, Jing, Cai, Jianzhi, Xie, Shiliang, Chi, Liangjie
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2009
• Subjects: Administration, Oral; Aged; Atorvastatin; Atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Biomarkers - blood; C-reactive protein; C-Reactive Protein - metabolism; Coronary artery bypass grafting; Coronary Artery Bypass, Off-Pump - adverse effects; Double-Blind Method; Drug Administration Schedule; Elective Surgical Procedures; Female; Heptanoic Acids - administration & dosage; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Odds Ratio; Preoperative Care; Pyrroles - administration & dosage; Risk Assessment; Risk Factors; Statins; Time Factors; Treatment Outcome
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-09-0352

Background: Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is still the most common postoperative arrhythmic complication. Previous studies report that patients undergoing preoperative statin therapy had a lower incidence of postoperative AF. This study aimed to assess the effect of preoperative atorvastatin therapy on preventing AF following off-pump CABG in a randomized, controlled trial. Methods and Results: The 140 consecutive patients undergoing elective off-pump CABG, without a history of AF or previous statin treatment, were enrolled and randomly assigned to a statin (atorvastatin 20 mg/day, n=71) or a control group (placebo, n=69) starting 7 days preoperatively. The primary endpoint was the occurrence of postoperative AF; secondary endpoints were major adverse in-hospital cardiac and cerebrovascular events and identification of variables predicting postoperative AF. Atorvastatin significantly reduced the incidence of postoperative AF and the postoperative peak C-reactive protein (CRP) level vs placebo (14% vs 34%, P=0.009; 126.5 ±22.3 vs 145.2 ±31.6 mg/L, P<0.0001). Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF (odds ratio (OR) 0.219, P=0.005), whereas a high postoperative CRP level was associated with increased risk (OR 2.011, P=0.013). Conclusions: Administration of atorvastatin 20 mg/day, initiated 1 week before elective off-pump CABG and continued in the postoperative period, significantly decreases postoperative AF. (Circ J 2009; 73: 2244-2249)