ATLANTA — A 40-mg dose of atorvastatin given 7 days before cardiac surgery reduced by 60% the relative risk of postoperative atrial fibrillation in a single-center, randomized trial of 200 patients.
“For the first time, a specific statin, at a specific dose, at a specific time” has been shown in a prospective, randomized, controlled trial to reduce postoperative atrial fibrillation in patients undergoing elective surgery, Dr. Germano Di Sciascio said at a press conference announcing the results of the Atorvastatin for Reduction of Myocardial Dysrhythmias After Cardiac Surgery (ARMYDA-3) study at the annual meeting of the American College of Cardiology.
The study results are not confirmatory, however, because the trial was small and the placebo group included more patients with diabetes (42 vs. 32) and left atrial enlargement (46 vs. 36) than did the atorvastatin group.
Postoperative atrial fibrillation, which develops in up to 40% of coronary artery bypass patients and 50% of valve surgery patients, increases the risk of complications and lengthens hospitalization.
In the study, 200 cardiac surgery patients, none of whom were already taking a statin, were randomized 7 days before their procedures to receive either 40 mg of atorvastatin (101 patients) or a placebo (99 patients). The incidence of postoperative atrial fibrillation was 57% in those on placebo and 35% in those given the statin, for a relative risk reduction of 60%. Length of stay also decreased from 6.9 days in the placebo patients to 6.3 days in the statin-treated patients, a statistically significant reduction.
The benefits of atorvastatin were apparent even when taking into account patient characteristics that might have inflated the risk of atrial fibrillation, including advanced age and high blood pressure.
Because none of the study patients took a statin prior to the study, the investigators were able to examine the observational link between statin therapy and reduced risk for postoperative atrial fibrillation. In addition, because atorvastatin was being used to prevent atrial fibrillation rather than to reduce cholesterol, a 40-mg dose was selected, rather than the typical 80-mg dose.
Dr. Di Sciascio, professor and chairman of cardiology and director of the department of cardiovascular sciences at the University Campus Bio-Medico in Rome, speculated that statins reduce the postoperative inflammatory response. Patients who went on to develop atrial fibrillation had higher C-reactive protein levels than did those who did not develop atrial fibrillation. In placebo and atorvastatin-treated patients, those who developed atrial fibrillation had postoperative peak C-reactive protein levels that exceeded 180 mg/L.
Dr. Di Sciascio had no conflicts of interest to declare, and the study was not a sponsored trial.