Meta-Analysis of 12 Trials Evaluating the Effects of Statins on Decreasing Atrial Fibrillation After Coronary Artery Bypass Grafting
2015; Elsevier BV; Volume: 115; Issue: 11 Linguagem: Inglês
10.1016/j.amjcard.2015.02.053
ISSN1879-1913
AutoresIslam Y. Elgendy, Mahmoud Ahmed, Tianyao Huo, Thomas M. Beaver, Anthony A. Bavry,
Tópico(s)Cardiac, Anesthesia and Surgical Outcomes
ResumoAtrial fibrillation (AF) is a common arrhythmia encountered after coronary artery bypass graft surgery (CABG) and is associated with poor outcomes. The purpose of this study was to examine whether initiation of statins before CABG reduces the risk of postoperative AF. We searched for clinical trials that randomized patients who underwent CABG to preoperative statin therapy versus placebo. We required that the trial reported the incidence of postoperative AF. Random-effects summary odds ratio (OR) were constructed. Sensitivity analysis for the trials that reported AF as a primary outcome along with subgroup analyses according to the different statins used was also conducted. Twelve trials with 2,980 patients met our inclusion criteria. Atorvastatin was tested in 8 trials, whereas rosuvastatin was studied in 2 studies. Statins were associated with a lower risk of postoperative AF (OR 0.42, 95% confidence interval [CI] 0.27 to 0.66, p <0.0001). There was benefit with atorvastatin (OR 0.35, 95% CI 0.25 to 0.50, p <0.0001) but not rosuvastatin (OR 0.69, 95% CI 0.28 to 1.71, p = 0.42). On sensitivity analysis limited to trials that reported AF as a primary outcome, the risk of postoperative AF was still reduced with statins (OR 0.40, 95% CI 0.25 to 0.90, p = 0.02). The mean duration of the hospital stay was significantly lower in the statin group: 8.5 ± 1.8 days versus 9.1 ± 2.2 days (p <0.0001). Statin therapy, particularly atorvastatin, before CABG was associated with a reduction in the risk of postoperative AF. Atrial fibrillation (AF) is a common arrhythmia encountered after coronary artery bypass graft surgery (CABG) and is associated with poor outcomes. The purpose of this study was to examine whether initiation of statins before CABG reduces the risk of postoperative AF. We searched for clinical trials that randomized patients who underwent CABG to preoperative statin therapy versus placebo. We required that the trial reported the incidence of postoperative AF. Random-effects summary odds ratio (OR) were constructed. Sensitivity analysis for the trials that reported AF as a primary outcome along with subgroup analyses according to the different statins used was also conducted. Twelve trials with 2,980 patients met our inclusion criteria. Atorvastatin was tested in 8 trials, whereas rosuvastatin was studied in 2 studies. Statins were associated with a lower risk of postoperative AF (OR 0.42, 95% confidence interval [CI] 0.27 to 0.66, p <0.0001). There was benefit with atorvastatin (OR 0.35, 95% CI 0.25 to 0.50, p <0.0001) but not rosuvastatin (OR 0.69, 95% CI 0.28 to 1.71, p = 0.42). On sensitivity analysis limited to trials that reported AF as a primary outcome, the risk of postoperative AF was still reduced with statins (OR 0.40, 95% CI 0.25 to 0.90, p = 0.02). The mean duration of the hospital stay was significantly lower in the statin group: 8.5 ± 1.8 days versus 9.1 ± 2.2 days (p <0.0001). Statin therapy, particularly atorvastatin, before CABG was associated with a reduction in the risk of postoperative AF. Atrial fibrillation (AF) is a common arrhythmia encountered after coronary artery bypass graft surgery (CABG) with an estimated frequency of about 10% to 65%.1Mathew J.P. Fontes M.L. Tudor I.C. Ramsay J. Duke P. Mazer C.D. Barash P.G. Hsu P.H. Mangano D.T. Investigators of the Ischemia Research and Education FoundationMulticenter Study of Perioperative Ischemia Research GroupA multicenter risk index for atrial fibrillation after cardiac surgery.JAMA. 2004; 291: 1720-1729Crossref PubMed Scopus (956) Google Scholar, 2Mariscalco G. Klersy C. Zanobini M. Banach M. Ferrarese S. Borsani P. Cantore C. Biglioli P. Sala A. Atrial fibrillation after isolated coronary surgery affects late survival.Circulation. 2008; 118: 1612-1618Crossref PubMed Scopus (232) Google Scholar Postoperative AF is associated with increased mortality, morbidity, and longer hospital stay.2Mariscalco G. Klersy C. Zanobini M. Banach M. Ferrarese S. Borsani P. Cantore C. Biglioli P. Sala A. Atrial fibrillation after isolated coronary surgery affects late survival.Circulation. 2008; 118: 1612-1618Crossref PubMed Scopus (232) Google Scholar The increased levels of systemic inflammatory markers perioperatively have been postulated as one of the underlying mechanisms for postoperative AF.3Aviles R.J. Martin D.O. Apperson-Hansen C. Houghtaling P.L. Rautaharju P. Kronmal R.A. Tracy R.P. Van Wagoner D.R. Psaty B.M. Lauer M.S. Chung M.K. Inflammation as a risk factor for atrial fibrillation.Circulation. 2003; 108: 3006-3010Crossref PubMed Scopus (1132) Google Scholar Statins or hydroxymethylglutaryl-CoA reductase inhibitors are important long-term medications in the management of patients with coronary artery disease who are awaiting CABG.4Hillis L.D. Smith P.K. Anderson J.L. Bittl J.A. Bridges C.R. Byrne J.G. Cigarroa J.E. Disesa V.J. Hiratzka L.F. Hutter Jr., A.M. Jessen M.E. Keeley E.C. Lahey S.J. Lange R.A. London M.J. Mack M.J. Patel M.R. Puskas J.D. Sabik J.F. Selnes O. Shahian D.M. Trost J.C. Winniford M.D. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice guidelines.Circulation. 2011; 124: e652-e735Crossref PubMed Scopus (574) Google Scholar Despite that, many eligible patients are not on statins.5Kulik A. Levin R. Ruel M. Mesana T.G. Solomon D.H. Choudhry N.K. Patterns and predictors of statin use after coronary artery bypass graft surgery.J Thorac Cardiovasc Surg. 2007; 134: 932-938Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar Beyond their lipid-lowering action, statins exert pleiotropic and anti-inflammatory effects,6Almuti K. Rimawi R. Spevack D. Ostfeld R.J. Effects of statins beyond lipid lowering: potential for clinical benefits.Int J Cardiol. 2006; 109: 7-15Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar in which some studies and meta-analyses have shown a reduction in the risk of postoperative AF.7Winchester D.E. Wen X. Xie L. Bavry A.A. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials.J Am Coll Cardiol. 2010; 56: 1099-1109Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 9Chen W.T. Krishnan G.M. Sood N. Kluger J. Coleman C.I. Effect of statins on atrial fibrillation after cardiac surgery: a duration- and dose-response meta-analysis.J Thorac Cardiovasc Surg. 2010; 140: 364-372Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar More recently, a large, multicenter randomized trial demonstrated that initiation of statins before CABG did not prevent the risk of postoperative AF.10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google Scholar Because of the uncertainty of the current available data, we conducted this comprehensive meta-analysis to evaluate whether statins initiated before CABG would reduce the risk of postoperative AF.MethodsWe performed a computerized literature search of the Medline database without language restriction from inception until January 2015 using the search strategy shown in Figure 1. We also searched both the Web of Science database and the Cochrane Register of Controlled Trials using the key words "statins" and "coronary artery bypass graft." Additionally, we searched for abstracts of the major scientific sessions until January 2015 using the same key words. To ensure that no potentially important studies were missed, the reference lists from the retrieved articles and previous meta-analyses were also checked.We selected studies that randomized patients to receive statin therapy versus placebo before CABG. We required that the study reported the incidence of AF in both arms. We excluded studies in which statins were initiated after the surgery. If the study reported that the patients were on long-term statin therapy, we required that statin therapy be discontinued before randomization.Two authors (IYE and AM) independently extracted data on study design, sample characteristics, sample size, intervention strategies, outcome measures, and other study characteristics from the included studies. Any discrepancies were resolved by consensus of the authors. For all clinical outcomes, we tabulated the number of events that occurred in each arm of each trial. When necessary for article clarification, we communicated with the corresponding author. For non-English articles, we used Google Translator (Google, Inc., Mountain View, California).The primary outcome was postoperative AF. Secondary outcomes were all-cause mortality, myocardial infarction (MI), stroke, renal failure, the length of intensive care unit stay, and the total duration of the hospital stay.For continuous variables, we calculated the mean and SD using 2-sided 2-sample t test. All outcomes were analyzed by the intention-to-treat analysis. Random-effects summary odds ratio (OR) were constructed using a DerSimonian-Laird model.11DerSimonian R. Laird N. Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188Abstract Full Text PDF PubMed Scopus (28451) Google Scholar We also performed fixed-effects summary OR using a Peto model for the rare outcomes.12Yusuf S. Peto R. Lewis J. Collins R. Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials.Prog Cardiovasc Dis. 1985; 27: 335-371Abstract Full Text PDF PubMed Scopus (2648) Google Scholar We assessed statistical heterogeneity for each outcome using the I2 statistic. I2 statistic values 50% were considered as low, moderate, and high degree of heterogeneity, respectively.13Higgins J.P. Thompson S.G. Deeks J.J. Altman D.G. Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560Crossref PubMed Scopus (38395) Google Scholar We examined the risk for publication bias using Harbord's method.14Harbord R.M. Egger M. Sterne J.A. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints.Stat Med. 2006; 25: 3443-3457Crossref PubMed Scopus (1293) Google Scholar We conducted this meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.15Moher D. Liberati A. Tetzlaff J. Altman D.G. PRISMA GroupPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535Crossref PubMed Scopus (14344) Google Scholar Furthermore, the quality of the trials was evaluated based on the adequate description of treatment allocation, blinded outcome assessment, and description of losses to follow-up.16Juni P. Altman D.G. Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials.BMJ. 2001; 323: 42-46Crossref PubMed Scopus (2261) Google Scholar All p values were 2 tailed, with statistical significance set at 0.05, and confidence intervals (CIs) were calculated at the 95% level for the overall estimates effect. All analyses were performed using STATA software, version 11 (STATA Corporation, College Station, Texas).In our primary analysis, all statins were combined regardless of dose, type, or duration of therapy. To enhance the quality of the analysis, we conducted a sensitivity analysis for the trials that reported AF as the primary outcome. We also conducted subgroup analyses according to the type of statin used. Additionally, we performed a random-effects meta-regression analysis to explore the effect of the number of days that statins were initiated before CABG on the logarithm of the OR for AF.ResultsA total of 12 studies met our inclusion criteria with a total of 2,980 patients.8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google Scholar, 17Baran Ç. Durdu S. Dalva K. Zaim Ç. Dogan A. Ocakoglu G. Gürman G. Arslan Ö. Akar A.R. Effects of preoperative short term use of atorvastatin on endothelial progenitor cells after coronary surgery: a randomized, controlled trial.Stem Cell Rev. 2012; 8: 963-971Crossref PubMed Scopus (48) Google Scholar, 18Sun Y. Ji Q. Mei Y. Wang X. Feng J. Cai J. Chi L. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting.Int Heart J. 2011; 52: 7-11Crossref PubMed Scopus (60) Google Scholar, 19Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic MDj Cirkovic M.V. Gradinac SDj Djukanovic B.P. Milojevic P.S. Steroids and statins: an old and a new anti-inflammatory strategy compared.Perfusion. 2011; 26: 31-37Crossref PubMed Scopus (33) Google Scholar, 20Spadaccio C. Pollari F. Casacalenda A. Alfano G. Genovese J. Covino E. Chello M. Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery: a randomized control study.J Cardiovasc Pharmacol. 2010; 55: 30-38Crossref PubMed Scopus (68) Google Scholar, 21Ji Q. Mei Y. Wang X. Sun Y. Feng J. Cai J. Xie S. Chi L. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting.Circ J. 2009; 73: 2244-2249Crossref PubMed Scopus (71) Google Scholar, 22Mannacio V.A. Iorio D. De Amicis V. Di Lello F. Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial.J Thorac Cardiovasc Surg. 2008; 136: 1541-1548Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 23Song Y.B. On Y.K. Kim J.H. Shin D.H. Kim J.S. Sung J. Lee S.H. Kim W.S. Lee Y.T. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery.Am Heart J. 2008; 156: 373.e9-373.e16Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 24Caorsi C. Pineda F. Munoz C. Pravastatin immunomodulates IL-6 and C-reactive protein, but not IL-1 and TNF-alpha, in cardio-pulmonary bypass.Eur Cytokine Netw. 2008; 19: 99-103PubMed Google Scholar, 25Tamayo E. Alonso O. Alvarez F.J. Castrodeza J. Flórez S. di Stefano S. Effects of simvastatin on acute-phase protein levels after cardiac surgery.Med Clin (Barc). 2008; 130: 773-775Crossref PubMed Scopus (14) Google Scholar, 26Chello M. Patti G. Candura D. Mastrobuoni S. Di Sciascio G. Agrò F. Carassiti M. Covino E. Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery.Crit Care Med. 2006; 34: 660-667Crossref PubMed Scopus (196) Google Scholar Nine of the trials were retrieved from the Medline search,8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 18Sun Y. Ji Q. Mei Y. Wang X. Feng J. Cai J. Chi L. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting.Int Heart J. 2011; 52: 7-11Crossref PubMed Scopus (60) Google Scholar, 20Spadaccio C. Pollari F. Casacalenda A. Alfano G. Genovese J. Covino E. Chello M. Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery: a randomized control study.J Cardiovasc Pharmacol. 2010; 55: 30-38Crossref PubMed Scopus (68) Google Scholar, 21Ji Q. Mei Y. Wang X. Sun Y. Feng J. Cai J. Xie S. Chi L. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting.Circ J. 2009; 73: 2244-2249Crossref PubMed Scopus (71) Google Scholar, 22Mannacio V.A. Iorio D. De Amicis V. Di Lello F. Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial.J Thorac Cardiovasc Surg. 2008; 136: 1541-1548Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 23Song Y.B. On Y.K. Kim J.H. Shin D.H. Kim J.S. Sung J. Lee S.H. Kim W.S. Lee Y.T. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery.Am Heart J. 2008; 156: 373.e9-373.e16Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 24Caorsi C. Pineda F. Munoz C. Pravastatin immunomodulates IL-6 and C-reactive protein, but not IL-1 and TNF-alpha, in cardio-pulmonary bypass.Eur Cytokine Netw. 2008; 19: 99-103PubMed Google Scholar, 25Tamayo E. Alonso O. Alvarez F.J. Castrodeza J. Flórez S. di Stefano S. Effects of simvastatin on acute-phase protein levels after cardiac surgery.Med Clin (Barc). 2008; 130: 773-775Crossref PubMed Scopus (14) Google Scholar, 26Chello M. Patti G. Candura D. Mastrobuoni S. Di Sciascio G. Agrò F. Carassiti M. Covino E. Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery.Crit Care Med. 2006; 34: 660-667Crossref PubMed Scopus (196) Google Scholar whereas the Web of Science database and the Cochrane Register of Controlled Trials search added 2 studies17Baran Ç. Durdu S. Dalva K. Zaim Ç. Dogan A. Ocakoglu G. Gürman G. Arslan Ö. Akar A.R. Effects of preoperative short term use of atorvastatin on endothelial progenitor cells after coronary surgery: a randomized, controlled trial.Stem Cell Rev. 2012; 8: 963-971Crossref PubMed Scopus (48) Google Scholar, 19Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic MDj Cirkovic M.V. Gradinac SDj Djukanovic B.P. Milojevic P.S. Steroids and statins: an old and a new anti-inflammatory strategy compared.Perfusion. 2011; 26: 31-37Crossref PubMed Scopus (33) Google Scholar and 1 study was presented at the European Society of Cardiology 2014 meeting.10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google ScholarAtorvastatin 20 mg was tested in 6 studies,18Sun Y. Ji Q. Mei Y. Wang X. Feng J. Cai J. Chi L. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting.Int Heart J. 2011; 52: 7-11Crossref PubMed Scopus (60) Google Scholar, 19Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic MDj Cirkovic M.V. Gradinac SDj Djukanovic B.P. Milojevic P.S. Steroids and statins: an old and a new anti-inflammatory strategy compared.Perfusion. 2011; 26: 31-37Crossref PubMed Scopus (33) Google Scholar, 20Spadaccio C. Pollari F. Casacalenda A. Alfano G. Genovese J. Covino E. Chello M. Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery: a randomized control study.J Cardiovasc Pharmacol. 2010; 55: 30-38Crossref PubMed Scopus (68) Google Scholar, 21Ji Q. Mei Y. Wang X. Sun Y. Feng J. Cai J. Xie S. Chi L. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting.Circ J. 2009; 73: 2244-2249Crossref PubMed Scopus (71) Google Scholar, 23Song Y.B. On Y.K. Kim J.H. Shin D.H. Kim J.S. Sung J. Lee S.H. Kim W.S. Lee Y.T. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery.Am Heart J. 2008; 156: 373.e9-373.e16Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 26Chello M. Patti G. Candura D. Mastrobuoni S. Di Sciascio G. Agrò F. Carassiti M. Covino E. Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery.Crit Care Med. 2006; 34: 660-667Crossref PubMed Scopus (196) Google Scholar atorvastatin 40 mg in 2 studies,8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 17Baran Ç. Durdu S. Dalva K. Zaim Ç. Dogan A. Ocakoglu G. Gürman G. Arslan Ö. Akar A.R. Effects of preoperative short term use of atorvastatin on endothelial progenitor cells after coronary surgery: a randomized, controlled trial.Stem Cell Rev. 2012; 8: 963-971Crossref PubMed Scopus (48) Google Scholar rosuvastatin 20 mg in 2 trials,10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google Scholar, 22Mannacio V.A. Iorio D. De Amicis V. Di Lello F. Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial.J Thorac Cardiovasc Surg. 2008; 136: 1541-1548Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar pravastatin 40 mg in 1 study,24Caorsi C. Pineda F. Munoz C. Pravastatin immunomodulates IL-6 and C-reactive protein, but not IL-1 and TNF-alpha, in cardio-pulmonary bypass.Eur Cytokine Netw. 2008; 19: 99-103PubMed Google Scholar and simvastatin 20 mg in 1 study.25Tamayo E. Alonso O. Alvarez F.J. Castrodeza J. Flórez S. di Stefano S. Effects of simvastatin on acute-phase protein levels after cardiac surgery.Med Clin (Barc). 2008; 130: 773-775Crossref PubMed Scopus (14) Google Scholar History of AF was an exclusion criteria in 5 studies,8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google Scholar, 18Sun Y. Ji Q. Mei Y. Wang X. Feng J. Cai J. Chi L. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting.Int Heart J. 2011; 52: 7-11Crossref PubMed Scopus (60) Google Scholar, 21Ji Q. Mei Y. Wang X. Sun Y. Feng J. Cai J. Xie S. Chi L. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting.Circ J. 2009; 73: 2244-2249Crossref PubMed Scopus (71) Google Scholar, 23Song Y.B. On Y.K. Kim J.H. Shin D.H. Kim J.S. Sung J. Lee S.H. Kim W.S. Lee Y.T. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery.Am Heart J. 2008; 156: 373.e9-373.e16Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar 1 study enrolled a small proportion patients (7% to 11%) with AF,19Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic MDj Cirkovic M.V. Gradinac SDj Djukanovic B.P. Milojevic P.S. Steroids and statins: an old and a new anti-inflammatory strategy compared.Perfusion. 2011; 26: 31-37Crossref PubMed Scopus (33) Google Scholar whereas the remainder of the studies did not specify. All the included studies were conducted in a single center except for 1 trial that was multicenter.10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google Scholar In 9 studies, patients underwent on-pump CABG.8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 17Baran Ç. Durdu S. Dalva K. Zaim Ç. Dogan A. Ocakoglu G. Gürman G. Arslan Ö. Akar A.R. Effects of preoperative short term use of atorvastatin on endothelial progenitor cells after coronary surgery: a randomized, controlled trial.Stem Cell Rev. 2012; 8: 963-971Crossref PubMed Scopus (48) Google Scholar, 18Sun Y. Ji Q. Mei Y. Wang X. Feng J. Cai J. Chi L. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting.Int Heart J. 2011; 52: 7-11Crossref PubMed Scopus (60) Google Scholar, 19Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic MDj Cirkovic M.V. Gradinac SDj Djukanovic B.P. Milojevic P.S. Steroids and statins: an old and a new anti-inflammatory strategy compared.Perfusion. 2011; 26: 31-37Crossref PubMed Scopus (33) Google Scholar, 20Spadaccio C. Pollari F. Casacalenda A. Alfano G. Genovese J. Covino E. Chello M. Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery: a randomized control study.J Cardiovasc Pharmacol. 2010; 55: 30-38Crossref PubMed Scopus (68) Google Scholar, 22Mannacio V.A. Iorio D. De Amicis V. Di Lello F. Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial.J Thorac Cardiovasc Surg. 2008; 136: 1541-1548Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 24Caorsi C. Pineda F. Munoz C. Pravastatin immunomodulates IL-6 and C-reactive protein, but not IL-1 and TNF-alpha, in cardio-pulmonary bypass.Eur Cytokine Netw. 2008; 19: 99-103PubMed Google Scholar, 25Tamayo E. Alonso O. Alvarez F.J. Castrodeza J. Flórez S. di Stefano S. Effects of simvastatin on acute-phase protein levels after cardiac surgery.Med Clin (Barc). 2008; 130: 773-775Crossref PubMed Scopus (14) Google Scholar, 26Chello M. Patti G. Candura D. Mastrobuoni S. Di Sciascio G. Agrò F. Carassiti M. Covino E. Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery.Crit Care Med. 2006; 34: 660-667Crossref PubMed Scopus (196) Google Scholar In 2 studies, patients underwent off-pump CABG,21Ji Q. Mei Y. Wang X. Sun Y. Feng J. Cai J. Xie S. Chi L. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting.Circ J. 2009; 73: 2244-2249Crossref PubMed Scopus (71) Google Scholar, 23Song Y.B. On Y.K. Kim J.H. Shin D.H. Kim J.S. Sung J. Lee S.H. Kim W.S. Lee Y.T. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery.Am Heart J. 2008; 156: 373.e9-373.e16Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar whereas another study allowed both on- and off-pump CABG.10Casadei B. Statin therapy in cardiac surgery (STICS). Presented at the European Society of Cardiology Scientific Sessions, Barcelona, Spain, September 2, 2014.Google Scholar In 8 studies, patients who underwent emergency CABG were excluded, whereas the remainder of the studies did not report the indication for CABG.8Patti G. Chello M. Candura D. Pasceri V. D'Ambrosio A. Covino E. Di Sciascio G. 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.Circulation. 2006; 114: 1455-1461Crossref PubMed Scopus (538) Google Scholar, 17Baran Ç. Durdu S. Dalva K. Zaim Ç. Dogan A. Ocakoglu G. Gürman G. Arslan Ö. Akar A.R. Effects of preoperative short term use of atorvastatin on endothelial progenitor cells after coronary surgery: a randomized, controlled trial.Stem Cell Rev. 2012; 8: 963-971Crossref PubMed Scopus (48) Google Scholar, 19Vukovic P.M. Maravic-Stojkovic V.R. Peric M.S. Jovic MDj Cirkovic M.V. Gradinac SDj Djukanovic B.P. Milojevic P.S. Steroids and statins: an old and a new anti-inflammatory strategy compared.Perfusion. 2011; 26: 31-37Crossref PubMed Scopus (33) Google Scholar, 20Spadaccio C. Pollari F. Casacalenda A. Alfano G. Genovese J. Covino E. Chello M. Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery: a randomized control study.J Cardiovasc Pharmacol. 2010; 55: 30-38Crossref PubMed Scopus (68) Google Scholar, 22Mannacio V.A. Iorio D. De Amicis V. Di Lello F. Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial.J Thorac Cardiovasc Surg. 2008; 136: 1541-1548Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 23Song Y.B. On Y.K. Kim J.H. Shin D.H. Kim J.S. Sung J. Lee S.H. Kim W.S. Lee Y.T. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery.Am Heart J. 2008; 156: 373.e9-373.e16Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 25Tamayo E. Alonso O. Alvarez F.J. Castrodeza J. Flórez S. di Stefano S. Effects of simvastatin on acute-phase protein levels after cardiac surgery.Med Clin (Barc). 2008; 130:
Referência(s)