Perioperative statin reduces postoperative atrial fibrillation but not acute kidney injury
Perioperative statin use prevents postoperative atrial fibrillation (POAF) but not myocardial infarction (MI) and acute kidney injury (AKI), according to a recent meta-analysis.
“[P]erioperative statin use is useful in preventing POAF after cardiac surgery, particularly in patients with [coronary artery bypass grafts (CABG)], and ameliorat[ing] inflammation,” said researchers.
“Therefore, statin should be given to patients undergoing CABG but not valve surgery for preventing POAF,” they continued.
The current meta-analysis included RCTs that compared POAF, AKI and MI outcomes in cardiac surgery patients treated with perioperative statins or with placebo or routine medications. The databases of PubMed, Cochrane Library and Embase were accessed.
Analysis of pooled data from 18 eligible randomized controlled trials (RCTs; n=3,995) showed that the risk of POAF was significantly lower with perioperative statin use (relative risk [RR], 0.69; 95 percent CI, 0.56 to 0.86; p=0.001). [Sci Rep 2017;7:10091]
In contrast, nine studies (n=3,214) showed that the risk of postoperative AKI was unaffected by the use of perioperative statin (RR, 0.98; 0.70 to 1.35; p=0.884), while 14 studies showed that MI risk was also unaffected by perioperative statin use (RR, 0.84; 0.58 to 1.23; p=0.765).
“[T]he decreased incidence of POAF might be owing to the anti-inflammation and antioxidant [properties] of statin,” the researchers explained.
Because the kidney is very vulnerable to severe injury, the anti-inflammation and antioxidant properties of statins may not be enough to significantly improve AKI, the researchers continued.
“Additionally, the high susceptivity of POAF on inflammation and oxidization might also be involved in the inconsistent finding between AKI and POAF,” they noted.
In terms of secondary clinical outcomes, perioperative statin use did not exert significant effects on mortality (RR, 1.13; 0.56 to 2.27; p=0.740), duration of ventilation (standard mean difference [SMD], -0.01; -0.44 to 0.42; p=0.967), length of stay in the intensive care unit (SMD, 0; -0.12 to 0.12; p=0.987) or length of hospital stay (SMD, -0.18; -0.37 to 0; p=0.051).
In contrast, peak concentrations of C-reactive protein (SMD, -0.43; -0.71 to -0.14; p=0.003) and cardiac troponin (SMD, -0.75; -1.04 to -0.47; p<0.001) were significantly reduced as a result of perioperative statin use.
Statins are drugs that lower cholestenone and stabilize atherosclerotic plaques, both of which are hallmarks of coronary artery disease. The drug “has been reported to contribute toward the stabilization of transmembrane ion channel, modification the extracellular matrix remodelling, and has effect of anti-inflammation and anti-oxidant,” according to the researchers.