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J Thorac Cardiovasc Surg 2008;135:405-411
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery

^a Henry Low Heart Center, Hartford Hospital, Hartford, Conn
^b University of Connecticut School of Pharmacy, Cardiac Pharmacology Service, Divisions of Cardiology and Drug Information, Hartford, Conn
^c University of Connecticut School of Medicine, Department of Internal Medicine, Hartford Hospital, Hartford, Conn
^d Divisions of Cardiology and Cardiothoracic Surgery, Hartford Hospital, Hartford, Conn
^e University of Connecticut School of Pharmacy, Storrs, Conn

Received for publication April 5, 2007; revisions received August 21, 2007; accepted for publication August 30, 2007.

^_* Address for reprints: Craig I. Coleman, PharmD, University of Connecticut School of Pharmacy, Pharmacy Practice, 80 Seymour Street, CB309, Hartford, CT 06102. (Email: ccolema{at}harthosp.org).

Objective: Recent studies have suggested that statins reduce atrial fibrillation after cardiothoracic surgery, but the use of proven prophylactic strategies such as beta-blockers and amiodarone in these studies was not provided. Therefore, we sought to determine whether preoperative statin use could reduce the incidence of post-cardiothoracic surgery atrial fibrillation in a population who already had a high background use of beta-blockers and appreciable use of prophylactic amiodarone.

Methods: Patients undergoing cardiothoracic surgery from the randomized, controlled Atrial Fibrillation Suppression Trials I, II, and III were evaluated in this nested cohort evaluation. The patients' demographics, surgical characteristics, medication use, and incidence of post-cardiothoracic surgery atrial fibrillation (atrial fibrillation >5 minutes duration) were uniformly and prospectively collected as part of Atrial Fibrillation Suppression Trials I, II, and III. Multivariate logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals.

Results: Overall, 331 patients (59.6%) received a statin preoperatively and 224 patients (40.4%) did not. The study population had an average age of 67.8 ± 8.6 years, 77.1% were male, 14.6% had valve surgery, 6.1% had a history of atrial fibrillation, 12.6% had a history of heart failure, 84.0% received postoperative beta-blockade, and 44.1% received postoperative prophylactic amiodarone. In total, 174 patients (31.4%) developed post-cardiothoracic surgery atrial fibrillation. Upon multivariate logistic regression, statin use was associated with a reduction in post-cardiothoracic surgery atrial fibrillation (adjusted odds ratio: 0.60; 95% confidence interval 0.37–0.99). Higher intensity statin dosing (equivalent of 40 mg of atorvastatin) seemed to be associated with the greatest reductions in post-cardiothoracic surgery atrial fibrillation (adjusted odds ratio: 0.45; 95% confidence interval 0.21–0.99).

Conclusions: In a population with appreciable beta-blocker and amiodarone use, adjunctive preoperative statin use was still associated with a 40% reduction in patients' odds of developing post-cardiothoracic surgery atrial fibrillation.

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