Effect of statins on atrial fibrillation after cardiac surgery: A duration- and dose-response meta-analysis
Received 20 November 2009; received in revised form 12 February 2010; accepted 25 February 2010. published online 12 April 2010.
Objective
This meta-analysis of randomized, controlled trials evaluated effects of statins on postoperative atrial fibrillation risk after cardiac surgery.
Methods
Randomized, controlled trials evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Register, and manual review of references without any language restrictions. End points examined included postoperative atrial fibrillation, intensive care unit stay, and total hospital stay. Meta-regression analyses were conducted to determine whether statins' effects were duration or dose dependent. A random-effects model was used in all instances.
Results
Eight trials (n = 774) were identified and subjected to meta-analysis. Statins reduced postoperative atrial fibrillation risk (relative risk 0.57, 95% confidence interval 0.45–0.72, P < .0001, risk difference −0.14, 95% confidence interval −0.20 to −0.08, P < .0001, number needed to treat 8) and total hospital stay (weighted mean difference −0.66 days, 95% confidence interval −1.01 to −0.30 days, P = .0004) relative to placebo. Intensive care unit stay was also reduced (weighted mean difference −0.17 days, 95% confidence interval −0.37 to 0.03 days, P = .09) but did not meet prespecified criteria for statistical significance. Metaregression analysis revealed association between duration of preoperative statin prophylaxis and postoperative atrial fibrillation risk reduction (3% reduction per day, P = .008). No association was found between statin dose used and risk reduction (P = .47).
Conclusions
Evidence suggests that statins are associated with reduced risk of postoperative atrial fibrillation and shorter hospital stay after cardiac surgery and that earlier therapy results in more profound benefit.
aUniversity of Connecticut School of Pharmacy, Storrs, Conn
bUniversity of Connecticut School of Medicine, Farmington, Conn
cDepartment of Drug Information, Hartford Hospital, Hartford, Conn
dDepartment of Cardiology, Hartford Hospital, Hartford, Conn
Address for reprints: Craig I. Coleman, PharmD, Associate Professor of Pharmacy Practice, University of Connecticut School of Pharmacy, 80 Seymour St, Hartford, CT 06102-5037.
ABSTRACT