Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery

Objective: Recent studies have suggested that statins reduce atrial fibrillation after cardiothoracic surgery, but the use of proven prophylactic strategies such as betablockers and amiodarone in these studies was not provided. Therefore, we sought to determine whether preoperative statin use could reduce the incidence of postcardiothoracic 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 6 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 postcardiothoracic 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.