Usefulness of statins pretreatment for the prevention of postoperative atrial fibrillation in patients undergoing cardiac surgery

Figures & data

Table I. Main characteristics of the randomized trials included in the meta-analysis.

Author	Blind method	Study site	No. of enrolled patients	Type of cardiac surgery	Definition of postoperative atrial fibrillation
Patti G, et al.	Double-blind	Single-center in Italy	200 (101 atorvastatin, 99 control)	All cardiac surgery with cardiopulmonary bypass	Postoperative atrial fibrillation that lasted ≥5 min within 30 days after surgery
Chello M, et al.	Double-blind	Single-center in Italy	40 (20 atorvastatin, 20 control)	Elective coronary bypass surgery with cardiopulmonary bypass	Postoperative atrial fibrillation during hospitalization
Song YB, et al.	Not available	Single-center in Korea	124 (62 atorvastatin, 62 control)	Elective off-pump coronary bypass surgery	Postoperative atrial fibrillation confirmed by 12-lead electrocardiogram during hospitalization
Caorsi C, et al.	Not available	Single-center in Chile	43 (21 pravastatin, 22 control)	Non-emergent coronary bypass surgery with cardiopulmonary bypass	Postoperative atrial fibrillation during hospitalization
Mannacio VA, et al.	Double-blind	Single-center in Italy	200 (100 rosuvastatin, 100 control)	Elective coronary bypass surgery with cardiopulmonary bypass	Postoperative atrial fibrillation during hospitalization
Ji Q, et al.	Double-blind	Single-center in China	140 (71 atorvastatin, 69 control)	Elective off-pump coronary bypass surgery	Postoperative atrial fibrillation that lasted ≥5 min during hospitalization
Tamayo E, et al.	Not available	Single-center in Spain	44 (22 simvastatin, 22 control)	Elective coronary bypass surgery with cardiopulmonary bypass	Postoperative atrial fibrillation during hospitalization
Spadaccio C, et al.	Double-blind	Single-center in Italy	50 (25 atorvastatin, 25 control)	Elective coronary bypass surgery with cardiopulmonary bypass	Postoperative atrial fibrillation during hospitalization

Table II. Base-line clinical and angiographic characteristics of the study population.

	Patti G, et al.(2006)		Chello M, et al.(2006)		Song YB, et al.(2008)		Caorsi C, et al.(2008)		Mannacio VA, et al.(2008)		Ji Q, et al.(2009)		Tamayo E, et al.(2009)		Spadaccio C, et al.(2010)
Trial	Statins (n = 101)	Placebo (n = 99)	Statins (n = 20)	Placebo (n = 20)	Statins (n = 62)	Placebo (n = 62)	Statins (n = 21)	Placebo (n = 22)	Statins (n = 100)	Placebo (n = 100)	Statins (n = 71)	Placebo (n = 69)	Statins (n = 22)	Placebo (n = 22)	Statins (n = 25)	Placebo (n = 25)
Age, year	66 ± 9	67 ± 8	66 ± 8	64 ± 7	62 ± 10	64 ± 9	68 ± 7	68 ± 7	61 ± 9	59 ± 8	65 ± 6	66 ± 9	68 ± 7	68 ± 7	66 ± 8	65 ± 7
Male, n (%)	80 (79)	67 (68)	16 (80)	50 (75)	39 (63)	42 (68)	17 (81)	19 (86)	75 (75)	70 (70)	48 (68)	49 (71)	17 (77)	18 (82)	13 (52)	14 (56)
Diabetes mellitus, n (%)	32 (32)	42 (42)	–	–	27 (47)	32 (52)	8 (38)	9 (41)	–	–	27 (38)	26 (38)	6 (27)	9 (41)	–	–
Cigarette smoking, n (%)	25 (25)	24 (24)	7 (35)	5 (25)	23 (37)	16 (26)	14 (67)	13 (59)	–	–	18 (25)	16 (23)	5 (23)	10 (46)	12 (48)	11 (44)
Hypertension, n (%)	91 (90)	82 (83)	10 (50)	8 (40)	35 (57)	37 (60)	17 (81)	16 (73)	25 (25)	21 (21)	21 (30)	20 (29)	5 (23)	11 (50)	13 (52)	12 (48)
Hyperlipoproteinemia, n (%)	19 (19)	20 (20)	–	–	15 (24)	15 (24)	16 (76)	17 (77)			14 (20)	13 (19)
NYHA class	–	–	2.2 ± 0.6	2.3 ± 0.6	–	–	1.6 ± 0.5	1.6 ± 0.5	–	–	–	–	2.0 ± 0.3	2.1 ± 0.4	2.2 ± 0.7	2.1 ± 0.7
I	–	–	2 (10)	2 (10)	–	–	8 (38)	9 (41)	–	–	–	–	–	–	4 (16)	4 (16)
II	–	–	12 (60)	11 (55)	–	–	13 (62)	13 (59)	–	–	–	–	–	–	13 (52)	14 (56)
III	–	–	6 (30)	7 (35)	–	–	0	0	–	–	–	–	–	–	8 (32)	7 (28)
LVEF (%)	52 ± 9	52 ± 10	–	–	58 ± 12	57 ± 11	–	–	–	–	56 ± 11	55 ± 10	61 ± 11	63 ± 10
Additional drugs
β-Blockers, n (%)	73 (72)	59 (60)	6 (30)	7 (35)	45 (73)	43 (69)	–	–	73 (73)	68 (68)	46 (65)	41 (59)	6 (27)	10 (46)	8 (32)	6 (24)
Calcium antagonists, n (%)	72 (71)	70 (71)	8 (40)	6 (30)	12 (19)	6 (10)	–	–	30 (30)	27 (27)	40 (56)	31 (45)	4 (18)	7 (32)	12 (100)	9 (100)
ACEI or ARB, n (%)	47 (47)	51 (52)	–	–	35 (57)	31 (50)	0	0	22 (22)	28 (28)	28 (39)	32 (46)	5 (23)	9 (41)
Nitrates, n (%)	–	–	13 (65)	12 (60)	–	–	–	–	–	–	–	–	15 (68)	16 (73)	14 (56)	13 (52)
Amiodarone, n (%)	1 (1)	1 (1)	–	–	–	–	–	–	10 (10)	12 (12)	–	–	–	–	–	–

LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; ACEI = angiotensin-converting enzyme inhibitors; ARB = angiotensin II receptor blockers.

Figure 1. Odds ratios of postoperative atrial fibrillation associated with statins versus control from individual studies and overall population. The size of the data markers (squares) is approximately proportional to the statistical weight of each trial.