Statin pretreatment and risk of in-hospital atrial fibrillation among patients undergoing cardiac surgery: a collaborative meta-analysis of 11 randomized controlled trials.
OBJECTIVE
Statin pretreatment in patients undergoing cardiac surgery is understood to prevent postoperative atrial fibrillation (AF). However, this is based on observational and limited randomized trial evidence, resulting in uncertainty about any genuine anti-arrhythmic benefits of these agents in this setting. We therefore aimed to quantify precisely the association between statin pretreatment and postoperative AF among patients undergoing cardiac surgery.


RESULTS
A detailed search of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012) was conducted, followed by a review of the reference lists of published studies and correspondence with trial investigators to obtain individual-participant data for meta-analysis. Evidence was combined across prospective, randomized clinical trials that compared the risk of postoperative AF among individuals randomized to statin pretreatment or placebo/control medication before elective cardiac surgery. Postoperative AF was defined as episodes of AF lasting ≥5 min. Overall, 1105 participants from 11 trials were included; of them, 552 received statin therapy preoperatively. Postoperative AF occurred in 19% of these participants when compared with 36% of those not treated with statins (odds ratio 0.41, 95% confidence interval 0.31-0.54, P < 0.00001, using a random-effects model). Atrial fibrillation prevention by statin pretreatment was consistent across different subgroups.


CONCLUSIONS
Short-term statin pretreatment may reduce the risk of postoperative AF among patients undergoing cardiac surgery.
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Giuseppe
G
Patti
Cardiovascular Sciences Research Centre, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
Rachel
R
Bennett
Cardiovascular Sciences Research Centre, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
Sreenivasa Rao Kondapally
SR
Seshasai
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Christopher P
CP
Cannon
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Ilaria
I
Cavallari
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Massimo
M
Chello
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Annunziata
A
Nusca
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Simona
S
Mega
Cardiovascular Department, Clinica Las Condes, Hospital Clinico de la Fuerza Aerea de Chile, Las Condes, Chile.
Carlos
C
Caorsi
Cardiovascular Diseases and Cardiac Surgery Departments, University Hospital UZ Leuven, Leuven, Belgium Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk, Belgium.
Cristiano
C
Spadaccio
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Young
Y
Keun On
Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
Vito
V
Mannacio
Department of Cardiovascular Surgery, Cumhuriyet University School of Medicine, Sivas, Turkey.
Ocal
O
Berkan
Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Mehmet B
MB
Yilmaz
Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Nurkay
N
Katrancioglu
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University, Shanghai, China.
Qiang
Q
Ji
Department of Cardiothoracic Surgery, King's College Hospital, London, UK.
Antonios
A
Kourliouros
Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Dikimevi, Turkey.
Çağdaş
Ç
Baran
Interventional Cardiology, San Filippo Neri Hospital of Rome, Rome, Italy.
Vincenzo
V
Pasceri
Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Dikimevi, Turkey.
Ahmet
A
Rüçhan Akar
Cardiovascular Sciences Research Centre, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
Juan
J
Carlos Kaski
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Germano
G
Di Sciascio
Cardiovascular Sciences Research Centre, St George's University of London, Cranmer Terrace, London SW17 0RE, UK koshray@gmail.com.
Kausik K
KK
Ray
D001281:Atrial Fibrillation / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiac surgery; Meta-analysis; Postoperative atrial fibrillation; Statins