Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting.
Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting. Atrial remodeling has been observed in AF and has been associated with the development of this arrhythmia. Because 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) have been demonstrated to modify remodeling, we hypothesized a protective role of statins against postoperative AF. We also hypothesized that extracellular matrix turnover and brain natriuretic peptide (BNP) might be related to such atrial remodeling. We studied 234 consecutive patients who underwent coronary artery bypass grafting (173 men; 65 +/- 9 years of age) in whom the occurrence of postoperative AF was monitored. In a subgroup of 66 patients, we measured plasma levels of matrix metalloproteinase-1 (MMP-1), its inhibitor, tissue inhibitor matrix metalloproteinase-1 (TIMP-1; as indexes of extracellular matrix remodeling), and N-terminus pro-BNP (related to left ventricular function) at baseline and at 24 hours after surgery. Of 234 patients, 66 (28.2%) developed postoperative AF. In multivariate analysis, previous AF was related to an increase in the development of AF (odds ratio 11.92, 95% confidence interval 2.37 to 59.98, p = 0.026), whereas statin use was related to a decrease in arrhythmia (odds ratio 0.52, 95% confidence interval 0.28 to 0.96, p = 0.038). A higher TIMP-1/MMP-1 ratio at 24 hours after surgery was present in those who did not develop postoperative AF (p = 0.043). Statin use was associated with increased TIMP-1 levels and TIMP-1/MMP-1 ratio (p = 0.027 and 0.036, respectively). No significant relations to N-terminus pro-BNP were seen. In conclusion, previous AF and nonuse of statins are significantly associated with AF after coronary artery bypass grafting. Statin use may be protective against AF after coronary artery bypass grafting, possibly due to alterations in the extracellular matrix and remodeling after coronary artery bypass grafting.
Marín
Francisco
F
Department of Cardiology, Hospital General University of Alicante, Alicante, Spain. fcomarino@hotmail.com
Pascual
Domingo A
DA
Roldán
Vanessa
V
Arribas
José María
JM
Ahumada
Miguel
M
Tornel
Pedro Luis
PL
Oliver
Clara
C
Gómez-Plana
Jesús
J
Lip
Gregory Y H
GY
Valdés
Mariano
M
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D020781:Matrix Metalloproteinase 1 / Q000097:blood; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019715:Tissue Inhibitor of Metalloproteinase-1; D020097:Natriuretic Peptide, Brain; D020781:Matrix Metalloproteinase 1