Acute Crit Care.  2024 Nov;39(4):507-516. 10.4266/acc.2024.00633.

Impact of perioperative high-intensity statin treatment on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis

• Lee Y
• Im S
• Kang Y
• Sohn SH
• Jang Mj
• Hwang HY

• KMID: 2563539
• DOI: http://doi.org/10.4266/acc.2024.00633

Abstract

Background
This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).
Methods
Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger’s test.
Results
Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40–80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27–0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment.
Conclusions
Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.

Keyword

atrial fibrillation; coronary artery bypass grafting; meta-analysis; statins

Figure

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  Figure 1. Flow diagram based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

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  Figure 2. Pooled analysis for the risk of the primary endpoint, i.e., postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) among patients who received perioperative high-intensity statin treatment (HIS group) compared to those who did not receive it (control group). Pooled estimates from both randomized controlled trials (RCTs) and a non-randomized study (NRS) showed that the use of perioperative high-intensity statin treatment was associated with a significant reduction in the incidence of POAF. OR: odds ratio. a) Number and proportion were from all study patients who underwent either CABG or valve surgery whereas the OR and 95% CI were from those who underwent CABG.

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  Figure 3. Subgroup analyses for the risk of the primary endpoint, i.e., postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients who received perioperative high-intensity statin treatment (HIS group) compared to those did not receive it (control group). The impact of the HIS on POAF was statistically significant in studies using atorvastatin but not in those using rosuvastatin (A). The impact was significant for both studies using a placebo and those using low-dose statins for control group patients (B). OR: odds ratio. a) Number and proportion were from all study patients who underwent either CABG or valve surgery whereas the OR and 95% CI were from those who underwent CABG.

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  Figure 4. Pooled analyses for the risks of the secondary endpoints, including (A) early mortality and (B) perioperative myocardial infarction (PMI) in patients who received perioperative high-intensity statin treatment (HIS group) compared to those who did not receive it (control group). Pooled estimates showed that the risk of the secondary outcomes was not significantly different between the two groups OR: odds ratio; RCT: randomized controlled trials.

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  Figure 5. Funnel plots and Egger’s tests for asymmetry for (A) the primary endpoint, postoperative atrial fibrillation (POAF), and secondary outcomes such as (B) early mortality and (C) perioperative myocardial infarction (PMI). The funnel plot indicated a potential lack of small studies reporting a non-significant effect of high-intensity statins on the primary endpoint. OR: odds ratio.

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