Inflammation modulatory effect of perioperative high-dose statin in prevention of post-operative atrial fibrillation in patients undergoing coronary artery bypass grafting
DOI:
https://doi.org/10.18203/2320-6012.ijrms20192155Keywords:
Atorvastatin, Atrial fibrillation, Coronary artery bypass grafting, StatinAbstract
Background: Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass grafting (CABG), occurring in 20% to 40% of patients. Statins exert pleiotropic effects which are largely independent from their lipid-lowering properties. The objective of this study was based on to affirm the evidence that perioperative statins have a significant role in preventing early postoperative AF in patients undergoing CABG.
Methods: A prospective, randomized, cohort study of all consecutive patients who underwent primary isolated on pump CABG surgery was performed. Patients were divided into two groups -statin and non-statin groups - to examine the influence of statins on early postoperative prevention of AF.
Results: In total, 127 patients who underwent isolated CABG were included in the study and were analysed. There were no significant differences in age, gender, history of cardiac infarction, concomitant diseases (hypertension, smoking, PPCI, hyperlipidaemia), cardiac functional grading (NYHA III-IV), electro- cardiograms, and preoperative medication. There were no significant differences in the average number of grafts where the left internal mammary artery was used as a bypass conduit, the surgical procedure or total cardiopulmonary bypass time, or aortic cross-clamping (ACC) time. In addition, there were no significant differences in the postoperative mechanical ventilation duration time, length of ICU stays or length of hospitalization between the two groups. The incidence of AF following CABG in the statin group was significantly lower than that in the non-statin group.
Conclusions: Oral atorvastatin 40 mg/d, initiated at least 1 week before the scheduled CABG and continued in the early postoperative period, significantly decreases the risk of post-operative AF.
References
Kolesov VI. Mammary artery-coronary artery anastomosis as a method of treatment of angina pectoris. J Thorac Cardiov Surg. 1967;54:535-44.
Favaloro RG. Saphenous vein autograft replacement of severe segmental coronary artery occlusion: operative technique. Ann Thorac Surg. 1968;5:334-9.
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135:1061-73.
Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993;56:539-4.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, Vliet VM, et al. Predictors of atrial fibrillation after coronary artery surgery: current trends and impact on hospital resources. Circulat. 1996;94(3):390-7.
Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery. A major morbid event?. Ann Surg. 1997; 226:501.
Filardo G, Hamilton C, Hebeler Jr RF, Hamman B, Grayburn P. New-onset postoperative atrial fibrillation after isolated coronary artery bypass graft surgery and long-term survival. Circ Cardiovas Qual Outcomes. 2009;2:164-9.
Ishii Y, Schuessler RB, Gaynor SL, Yamada K, Fu AS, Boineau JP, et al. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulat. 2005;111:2881.
Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri, A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulat. 1997;96(4):1180-4.
Marcus GM, Whooley MA, Glidden DV, Pawlikowska L, Zaroff JG, Olgin JE. Interleukin-6 and atrial fibrillation in patients with coronary artery disease: data from the Heart and Soul Study. Am. Heart J. 2008;155:303-9.
Liu T, Li L, Korantzopoulos P, Goudevenos JA, Li G. Association between C-reactive protein and recurrence of atrial fibrillation after successful electrical cardioversion: a metaanalysis. J Am Coll Cardiol. 2007;49:1642-8.
Dobrev D, Nattel S. Calcium handling abnormalities in atrial fibrillation as a target for innovative therapeutics. J. Cardiov Pharmacol. 2008;52:293-9.
Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Med Sci Monit. 2003;9:225-9.
Laufs U, Fata VL, Liao JK. Inhibition of 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase blocks hypoxia-mediated downregulation of endothelial nitric oxide synthase. J Biol Chem. 1997;272:31725-9.
Savelieva I, Kourliouros A, Camm J. Primary and secondary prevention of atrial fibrillation with statins and polyunsaturated fatty acids: review of evidence and clinical relevance. Arch Pharmacol. 2010;381:1-13.
Romano M, Mezzetti A, Marulli C, Ciabattoni G, Febo F, Di SI, et.al. Fluvastatin reduces soluble P-selectin and ICAM-1 levels in hypercholesterolemic patients: role of nitric oxide. J. Investig Med. 2002;48:183-9.
Lin CP, Chen YH, Lin WT, Leu HB, Liu TZ, Huang SL, et al. Direct effect of statins on homocysteine-induced endothelial adhesiveness: potential impact to human atherosclerosis. Eur J Clin Invest. 2008;38:106-6.
Vaughan CJ, Gotto AM, Basson CT. The evolving role of statins in themanagement of atherosclerosis. J Am Coll Cardiol. 2000;35:1-10.
Romano M, Romano M, Diomede L, Sironi M, Massimiliano L, Sottocorno M, et al. Inhibition of monocyte chemotactic protein-1 synthesis by statins. Lab. Invest. 2000;80:1095.
Liang YJ, Shyu KG, Wang BW, Lai LP. Simvastatin inhibits C-reactive protein-induced proinflammatory changes in endothelial cells by decreasing mevolanate pathway products. Cardiol. 2008;110:182-90.
Kang BY, Mehta JL. Rosuvastatin attenuates Ang II-mediated cardiomyocyte hypertrophy via inhibition of LOX-1. J Cardiovas Pharmacol Ther. 2009;14:283-91.
Chan AW, Bhatt DL, Chew DP. Relation of inflammation and benefit of statins after percutaneous coronary interventions. Circulat. 2003;107:1750-6.
Hanna, IR, Heeke B, Bush H, Brosius L, King-Hageman D, Dudley SC Jr, et al. Lipid-lowering druguse is associated with reduced prevalence of atrial fibrillation inpatients with left ventricular systolic dysfunction. Heart Rhy. 2006;3:881-6.
Maggioni AP, Fabbri G, Lucci D, Marchioli R, Franzosi MG, Latini R, et al. GISSI-HF Investigators. Effects of rosuvastatin on atrial fibrillation occurrence: ancillary results of the GISSI-HF trial. Eur. Heart J. 2009;30:2327-36.
Dotani MI, Elnicki DM, Jain AC, Gibson CM. Effect of preoperative statin therapy and cardiac outcomes after coronaryartery bypass grafting. Am J Cardiol. 2000;86:1128-30.
Marin F, Pascual DA, Roldan V, Arribas JM, Ahumada M, Tornel PL, et al. Statins and postoperative risk of atrial fibrillation followingcoronary artery bypass grafting. Am J Cardiol. 2006;97:55-60.
Lertsburapa K, White CM, Kluger J, Faheem O, Hammond J, Coleman CI. Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. J Thorac Cardiovasc Surg. 2008;135:405-11.
Kourliouros A, De Souza A, Roberts N, Marciniak A, Tsiouris A, Valencia O, et al. Dose-related effect of statins on atrial fibrillation after cardiac surgery. Ann Thorac Surg. 2008;85:1515-20.
Song YB, On YK, Kim JH, Shin DH, Kim JS, Sung J, et al. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. Am Heart J. 2008;156:9-6.
Sun Y, Ji Q, Mei Y, Wang X, Feng J, Cai J, et al. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronaryartery bypass grafting. Int Heart J. 2011;52:7-11.
Chen WT, Krishnan GM, Sood N, Kluger J, Coleman CI. Effects of statins on atrial fibrillation after cardiac surgery: aduration- and dose-response meta-analysis. J Thorac Cardiovasc Surg. 2010; 140:364-72.
Sakamoto H, Watanabe Y, Satou M. Do preoperative statins reduceatrial fibrillation after coronary artery bypass grafting? Ann Thorac Cardiovasc Surg. 2011;17:376-82.
Kourliouros A, De Souza A, Roberts N. Dose-related effect of statins on atrial fibrillation after cardiac surgery. Ann Thorac Surg. 2008;85:1515-20.
Subramaniam K, Koch CG, Bashour A. Preoperative statin intakeand morbid events after isolated coronary artery bypass grafting. J Clin Anesth. 2008;20:4-11.
Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulat. 2003;108:3006-10.
Patti G, Chello M, Candura D. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of myocardial dysrhythmia after cardiac surgery) study. Circulat. 2006;114:1455-61.