Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-blind Randomized Comparative Trial
Abstract
Background: Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF.
Methods: The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared.
Results: Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01).
Conclusion: Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.
2. European Heart Rhythm Association; Heart Rhythm Society; Fuster V, Rydén LE, Cannom DS, Crijns HJ, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006;48:854-906.
3. Blum S, Meyre P, Aeschbacher S, Berger S, Auberson C, Briel M, Osswald S, Conen D. Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis. Heart Rhythm 2019;16:502-510.
4. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019;140:e125-e151.
5. Benedetto U, Gaudino MF, Dimagli A, Gerry S, Gray A, Lees B, Flather M, Taggart DP; ART Investigators*. Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery. Circulation 2020;142:1320-1329.
6. Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis 2018;10:1960-1967.
7. Khan MF, Wendel CS, Movahed MR. Prevention of post-coronary artery bypass grafting (CABG) atrial fibrillation: efficacy of prophylactic beta-blockers in the modern era: a meta-analysis of latest randomized controlled trials. Ann Noninvasive Electrocardiol 2013;18:58-68.
8. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM Jr, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; Society of Cardiovascular Anesthesiologists; Society of Thoracic Surgeons. 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. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011;58:e123-210.
9. Mostafa A, El-Haddad MA, Shenoy M, Tuliani T. Atrial fibrillation post cardiac bypass surgery. Avicenna J Med 2012;2:65-70.
10. Adedinsewo D, Taka N, Agasthi P, Sachdeva R, Rust G, Onwuanyi A. Prevalence and Factors Associated With Statin Use Among a Nationally Representative Sample of US Adults: National Health and Nutrition Examination Survey, 2011-2012. Clin Cardiol 2016;39:491-496.
11. Nomani H, Mohammadpour AH, Reiner Ž, Jamialahmadi T, Sahebkar A. Statin Therapy in Post-Operative Atrial Fibrillation: Focus on the Anti-Inflammatory Effects. J Cardiovasc Dev Dis 2021;8:24.
12. Yang Q, Qi X, Li Y. The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2014;14:99.
13. Liu T, Korantzopoulos P, Li L, Li G. Preventive effects of rosuvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials. Int J Cardiol 2013;167:3058-3560.
14. Elgendy IY, Mahmoud A, Huo T, Beaver TM, Bavry AA. Meta-analysis of 12 trials evaluating the effects of statins on decreasing atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2015;115:1523-1528.
15. Takagi H, Umemoto T. A meta-analysis of randomized head-to-head trials of atorvastatin versus rosuvastatin for reductions in C-reactive protein. Int J Cardiol 2012;154:78-81.
16. Abaci O, Kocas C, Oktay V, Yildiz CE, Kilickesmez KO, Coskun U, Yildiz A, Yigit Z. Comparison of rosuvastatin versus atorvastatin for preventing postoperative atrial fibrillation. Heart Surg Forum 2013;16:E158-161.
17. Kendrach MG, Kelly-Freeman M. Approximate equivalent rosuvastatin doses for temporary statin interchange programs. Ann Pharmacother 2004;38:1286-1292.
18. Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J 2015;79:495-502.
19. Suleiman MS, Zacharowski K, Angelini GD. Inflammatory response and cardioprotection during open-heart surgery: the importance of anaesthetics. Br J Pharmacol 2008;153:21-33.
20. Sánchez-Quiñones J, Marín F, Roldán V, Lip GY. The impact of statin use on atrial fibrillation. QJM 2008;101:845-861.
21. Haghjoo M, Heidarali M, Nikfarjam S, Peighambari M, Alizadeh-Ghavidel A, Hosseini S, Jalali A. Very late effects of postoperative atrial fibrillation on outcome of coronary artery bypass graft surgery. Res Cardiovasc Med 2012;1:23-27.
22. Shirzad M, Karimi A, Tazik M, Aramin H, Hossein Ahmadi S, Davoodi S, Marzban M. Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery. Rev Esp Cardiol 2010;63:1054-60.
23. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, Collins JJ Jr, Cohn LH, Burstin HR. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996;94:390-397.
24. Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, Tarazi R, Shroyer AL, Sethi GK, Grover FL, Hammermeister KE. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 1997;226:501-511.
25. Sai C, Li J, Ruiyan M, Yingbin X. Atorvastatin prevents postoperative atrial fibrillation in patients undergoing cardiac surgery. Hellenic J Cardiol 2019;60:40-47.
| Files | ||
| Issue | Vol 18 No 2 (2023): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v18i2.13321 | |
| Keywords | ||
| Atrial fibrillation Coronary artery bypass Rosuvastatin calcium Atorvastatin | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
