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J Thorac Cardiovasc Surg 2008;136:1541-1548
© 2008 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: A randomized trial

^a Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy
^b Department of Cardiovascular Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy

Received for publication February 7, 2008; revisions received May 23, 2008; accepted for publication June 19, 2008.

^_* Address for reprints: Vito A. Mannacio, MD, Via S. Domenico 62, 80127 Naples, Italy. (Email: vitomannacio2{at}libero.it).

Objective: Myocardial disease without evidence of myocardial infarction is a frequent complication after cardiac surgery during cardiopulmonary bypass. Statins might be protective, but their efficacy has not been established in randomized trials.

Methods: Two hundred patients undergoing coronary surgery were enrolled. They were randomized to rosuvastatin (20 mg/d, n = 100) or placebo (n = 100) starting 1 week before the operation. Troponin I, myoglobin, creatine kinase–MB mass, and high-sensitivity C-reactive protein were used as markers of myocardial injury, and their values were determined at baseline and at regular intervals after the operation. Electrocardiography and echocardiography were performed before and after the operation.

Results: Myocardial disease was diagnosed when troponin I, myoglobin, and creatine kinase–MB mass values were above the upper normal limit without evidence of electrocardiographic changes, echocardiographic changes, or both. The percentages of marker level increase indicative of myocardial disease were determined in the placebo versus statin groups and were as follows: troponin I, 35% versus 65% (P < .0001); myoglobin, 39% versus 72% (P < .0001); creatine kinase–MB mass, 22% versus 40% (P = .0002). Peak postoperative values of troponin I (0.16 ± 0.15 vs 0.32 ± 0.26 ng/mL, P = .0008), myoglobin (72.25 ± 25 vs 98.31 ± 31 ng/mL, P < .0001), and creatine kinase–MB mass (3.9 ± 3.3 vs 9.3 ± 8.1 ng/mL, P < .0001) were significantly higher in the placebo group. High-sensitivity C-reactive protein values were increased in 58% of pretreated versus 88% of the control patients (15.4 ± 2.5 vs 17.2 ± 3.4 mg/L, P < .0001). In high-risk patients myocardial disease was observed more frequently but significantly less in statin-pretreated patients.

Conclusions: Statin pretreatment reduces myocardial damage after coronary surgery and could improve both short- and long-term results.