Preoperative statins reduce AF risk after CABG surgery
MedWire News: The use of statins before coronary artery bypass graft (CABG) surgery lowers the risk for postoperative atrial fibrillation (AF), conclude Cochrane reviewers.
Preoperative statin therapy also reduced length of hospital stay, but had no effect on the risk for postoperative mortality or the risk for stroke.
The researchers, led by Oliver Liakopoulos (University of Cologne, Germany), suggest it is "reasonable and in compliance with existing guidelines" to intensify statins before surgery, and to reinitiate the regimen after CABG, in hyperlipidemic patients with coronary heart disease.
As described in The Cochrane Library, the group conducted a systematic review and meta-analysis of 11 randomized, controlled clinical trials with 984 patients undergoing on- or off-pump CABG surgery. The majority of patients pretreated with statins received 20 mg or 40 mg of atorvastatin.
Measuring the incidence of AF after a median follow up of 22.8 days, 19% of the statin-treated patients developed AF compared with 35.6% of patients who did not receive the lipid-lowering drug (odds ratio 0.40).
There was a trend toward a short-term reduction in the risk for myocardial infarction and renal failure, but the reductions in risk did not reach statistical significance. Length of stay in the intensive care unit and in the hospital was significantly reduced in the statin-treated patients, although significant heterogeneity in the studies was observed.
There was no significant effect of preoperative statin therapy on the risk for stroke or mortality.
Other published data have suggested that pretreatment with a statin reduces the risk for early mortality, stroke, and AF, but these studies were observational and included all types of cardiac surgery.
Liakopoulos and colleagues caution against overinterpreting their positive findings, stating there is insufficient evidence to recommend statins in all CABG patients undergoing surgery.
"There is sparse evidence for a benefit of a statin therapy for high-risk patient subgroups and those undergoing other cardiac procedures (for example, valvular operations or combined procedures)," note the researchers.
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