By Liam O’Neill, ESC, Barcelona 2014.
Intensive perioperative statin therapy in patients undergoing CABG surgery doesn’t protect against post-op atrial fibrillation or heart muscle injury, according to a large randomized clinical trial.
‘There are many reasons why these patients should be put on statin treatment but the prevention of postoperative complications is now not one of them,’ said study presenter Barbara Casadei from the University of Oxford, UK.
The results from small trials have shown that the incidence of AF can be halved with two or three days of statin treatment prior to surgery, and heart muscle injury, MI and even postoperative death prevented in some cases. However, said Casadei, these trials were limited by their small size (only 1300 patients were involved across 14 trials), assessments were not always blind, and were only performed in statin naive patients.
STICS was a double-blind prospective trial which randomised 1922 patients in sinus rhythm with no history of AF to rosuvastatin (20 mg daily) or placebo. The patients had no history of AF. Treatment was started up to eight days prior to surgery, and continued for five days after surgery.
Postop AF occurred in 21% of those given high-intensity therapy with rosuvastatin and 20% of placebo-treated controls.
Whether patients had received statins or non-steroidal anti-inflammatory drugs prior to surgery, were treated for longer than two days, or had on or off-pump surgery made no difference to postoperative AF outcomes. The study furthermore found no difference in cardiac muscle injury (measured by troponin levels) between the two groups.
‘While this is a definitive answer for this population - that statins do not prevent AF after CABG - I’d don’t want this message to get mixed up with the need for treating these patients with statins for their long term effects in lowering LDL cholesterol,’ said Casadei.