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S.L. Goh et al. / Interactive CardioVascular and Thoracic Surgery
using propensity score analysis showed that preoperative statin therapy was not associated with decreased incidence of postoperative AF. Patti et al. [13] examined the effects of atorvastatin (40 mg/day for 7 days) on postoperative AF in 200 patients who underwent elective CABG. Patients in the atorvastatin group had lower CRP levels and better AF-free survival at 30 days (Kaplan–Meier analysis) compared with controls. Multivariate analysis showed an association between postoperative peak CRP >166 mg/l and higher risk of AF.
CLINICAL BOTTOM LINE In conclusion, several systematic reviews and randomized controlled trials support the use of statin therapy preoperatively to reduce the incidence and risk of developing AF after elective cardiac surgery. There is some evidence that this effect is greater with longer duration of therapy, and there may be some advantage of different doses and of different statins. However, the optimal dose, type of statin and duration have yet to be defined, and cannot be concluded from the current evidence. Conflict of interest: none declared.
REFERENCES [1] Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact CardioVasc Thorac Surg 2003;2:405–9. [2] Kuhn EW, Liakopoulos OJ, Stange S, Deppe AC, Slotosch I, Choi YH et al. Preoperative statin therapy in cardiac surgery: a meta-analysis of 90,000 patients. Eur J Cardiothorac Surg 2014;45:17–26. [3] Vukovic PM, Maravic-Stojkovic VR, Peric MS, Jovic M, Cirkovic MV, Gradinac SD et al. Steroids and statins: an old and a new anti-inflammatory strategy compared. Perfusion 2011;26:31–7. [4] Tamura K, Arai H, Ito F, Someya T, Ushiyama T, Miyagi N. Pravastatin treatment before coronary artery bypass grafting for reduction of postoperative atrial fibrillation. Gen Thorac Cardiovasc Surg 2010;58:120–5. [5] Yin L, Wang Z, Wang Y, Ji G, Xu Z. Effect of statins in preventing postoperative atrial fibrillation following cardiac surgery. Heart Lung Circ 2010; 19:579–83. [6] Chen WT, Krishnan GM, Sood N, Kluger J, Coleman CI. Effect of statins on atrial fibrillation after cardiac surgery: a duration- and dose-response meta-analysis. J Thorac Cardiovasc Surg 2010;140:364–72. [7] Alves RJ, Campos RN, Nakiri K. Chronic and regular use of statin prevents atrial fibrillation in period after cardiac surgery. Arq Bras Cardiol 2010;95: 614–20. [8] Ji Q, Mei Y, Wang X, Sun Y, Feng J, Cai J et al. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting. Circ J 2009;73:2244–9. [9] Kourliouros A, De Souza A, Roberts N, Marciniak A, Tsiouris A, Valencia O et al. Dose-related effect of statins on atrial fibrillation after cardiac surgery. Ann Thorac Surg 2008;85:1515–20.
[10] 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: 1541–8. [11] Song YB, On YK, Kim JH, Shin DH, Kim JS, Sung J 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: 373. e9–16. [12] Virani SS, Nambi V, Razavi M, Lee VV, Elayda M, Wilson JM et al. Preoperative statin therapy is not associated with a decrease in the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery. Am Heart J 2008;155:541–6. [13] Patti G, Chello M, Candura D, Pasceri V, D’Ambrosio A, Covino E et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation 2006;114:1455–61.
eComment. Statins: an indispensable part of this game Authors: Omer Uz and Ugur Kucuk GATA Haydarpasa Training Hospital, Department of Cardiology, Istanbul, Turkey doi: 10.1093/icvts/ivu452 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We have read the article of Goh et al. with great interest [1]. Authors reported that preoperative statin therapy in patients undergoing elective cardiac surgery is associated with the following: (i) a lower incidence and risk of developing postoperative atrial fibrillation (AF); (ii) reduced stroke; (iii) a shorter hospital stay and; (iv) reduced levels of inflammatory markers postoperatively. Aydin et al. have evaluated the efficacy of statin therapy started in the early postoperative period for prevention from new onset AF after isolated coronary artery bypass grafting (CABG). Their study consisted of 60 consecutive patients, who underwent elective isolated CABG. Patients were divided into two groups to examine the influence of statins: those with postoperative statin therapy (the statin group) and those without it (the non-statin group). They reported that preoperative C-reactive protein (CRP) levels showed no significant differences either between the statin and the non-statin groups. However, CRP levels on postoperative day 14 were significantly lower in the statin group compared with the non-statin group. Besides, CRP levels were significantly lower in patients without AF versus those with AF. When aforementioned studies are taken into consideration, inflammation can be a key mechanism for postoperative AF. We think that statins will remain an indispensable part of this game. Conflict of interest: none declared. References [1] Goh SL, Yap KH, Chua KC, Chao VT. Does preoperative statin therapy prevent postoperative atrial fibrillation in patients undergoing cardiac surgery? Interact CardioVasc Thorac Surg 2015;20:422–8. [2] Aydin U, Yilmaz M, Duzyol C, Ata Y, Turk T, Orhan AL et al. Efficiency of postoperative statin treatment for preventing new onset postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting: a prospective randomized study. Anadolu Kardiyol Derg 2014; doi:10.5152/ akd.2014.5531.
S.L. Goh et al. / Interactive CardioVascular and Thoracic Surgery
using propensity score analysis showed that preoperative statin therapy was not associated with decreased incidence of postoperative AF. Patti et al. [13] examined the effects of atorvastatin (40 mg/day for 7 days) on postoperative AF in 200 patients who underwent elective CABG. Patients in the atorvastatin group had lower CRP levels and better AF-free survival at 30 days (Kaplan–Meier analysis) compared with controls. Multivariate analysis showed an association between postoperative peak CRP >166 mg/l and higher risk of AF.
CLINICAL BOTTOM LINE In conclusion, several systematic reviews and randomized controlled trials support the use of statin therapy preoperatively to reduce the incidence and risk of developing AF after elective cardiac surgery. There is some evidence that this effect is greater with longer duration of therapy, and there may be some advantage of different doses and of different statins. However, the optimal dose, type of statin and duration have yet to be defined, and cannot be concluded from the current evidence. Conflict of interest: none declared.
REFERENCES [1] Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact CardioVasc Thorac Surg 2003;2:405–9. [2] Kuhn EW, Liakopoulos OJ, Stange S, Deppe AC, Slotosch I, Choi YH et al. Preoperative statin therapy in cardiac surgery: a meta-analysis of 90,000 patients. Eur J Cardiothorac Surg 2014;45:17–26. [3] Vukovic PM, Maravic-Stojkovic VR, Peric MS, Jovic M, Cirkovic MV, Gradinac SD et al. Steroids and statins: an old and a new anti-inflammatory strategy compared. Perfusion 2011;26:31–7. [4] Tamura K, Arai H, Ito F, Someya T, Ushiyama T, Miyagi N. Pravastatin treatment before coronary artery bypass grafting for reduction of postoperative atrial fibrillation. Gen Thorac Cardiovasc Surg 2010;58:120–5. [5] Yin L, Wang Z, Wang Y, Ji G, Xu Z. Effect of statins in preventing postoperative atrial fibrillation following cardiac surgery. Heart Lung Circ 2010; 19:579–83. [6] Chen WT, Krishnan GM, Sood N, Kluger J, Coleman CI. Effect of statins on atrial fibrillation after cardiac surgery: a duration- and dose-response meta-analysis. J Thorac Cardiovasc Surg 2010;140:364–72. [7] Alves RJ, Campos RN, Nakiri K. Chronic and regular use of statin prevents atrial fibrillation in period after cardiac surgery. Arq Bras Cardiol 2010;95: 614–20. [8] Ji Q, Mei Y, Wang X, Sun Y, Feng J, Cai J et al. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting. Circ J 2009;73:2244–9. [9] Kourliouros A, De Souza A, Roberts N, Marciniak A, Tsiouris A, Valencia O et al. Dose-related effect of statins on atrial fibrillation after cardiac surgery. Ann Thorac Surg 2008;85:1515–20.
[10] 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: 1541–8. [11] Song YB, On YK, Kim JH, Shin DH, Kim JS, Sung J 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: 373. e9–16. [12] Virani SS, Nambi V, Razavi M, Lee VV, Elayda M, Wilson JM et al. Preoperative statin therapy is not associated with a decrease in the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery. Am Heart J 2008;155:541–6. [13] Patti G, Chello M, Candura D, Pasceri V, D’Ambrosio A, Covino E et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation 2006;114:1455–61.
eComment. Statins: an indispensable part of this game Authors: Omer Uz and Ugur Kucuk GATA Haydarpasa Training Hospital, Department of Cardiology, Istanbul, Turkey doi: 10.1093/icvts/ivu452 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We have read the article of Goh et al. with great interest [1]. Authors reported that preoperative statin therapy in patients undergoing elective cardiac surgery is associated with the following: (i) a lower incidence and risk of developing postoperative atrial fibrillation (AF); (ii) reduced stroke; (iii) a shorter hospital stay and; (iv) reduced levels of inflammatory markers postoperatively. Aydin et al. have evaluated the efficacy of statin therapy started in the early postoperative period for prevention from new onset AF after isolated coronary artery bypass grafting (CABG). Their study consisted of 60 consecutive patients, who underwent elective isolated CABG. Patients were divided into two groups to examine the influence of statins: those with postoperative statin therapy (the statin group) and those without it (the non-statin group). They reported that preoperative C-reactive protein (CRP) levels showed no significant differences either between the statin and the non-statin groups. However, CRP levels on postoperative day 14 were significantly lower in the statin group compared with the non-statin group. Besides, CRP levels were significantly lower in patients without AF versus those with AF. When aforementioned studies are taken into consideration, inflammation can be a key mechanism for postoperative AF. We think that statins will remain an indispensable part of this game. Conflict of interest: none declared. References [1] Goh SL, Yap KH, Chua KC, Chao VT. Does preoperative statin therapy prevent postoperative atrial fibrillation in patients undergoing cardiac surgery? Interact CardioVasc Thorac Surg 2015;20:422–8. [2] Aydin U, Yilmaz M, Duzyol C, Ata Y, Turk T, Orhan AL et al. Efficiency of postoperative statin treatment for preventing new onset postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting: a prospective randomized study. Anadolu Kardiyol Derg 2014; doi:10.5152/ akd.2014.5531.
