The Effect of High-Dose Atorvastatin on Major Adverse Cardiovascular Events in Patients Undergoing Non-Cardiac Surgery: A Triple-Blind Randomized Clinical Trial

Abstract

Background: Cardiovascular complications account for a substantial proportion of perioperative complications. This study aims to evaluate whether preoperative high-dose atorvastatin reduces postoperative changes in serum high-sensitivity cardiac troponin (hs-cTn) concentrations in patients at elevated cardiac risk undergoing non-cardiac surgery.

Methods: In this triple-blinded, parallel-group, randomized controlled trial, adults with Revised Cardiac Risk Index (RCRI) ≥ 1 scheduled for non-cardiac surgery were randomized (1:1) to receive atorvastatin 80 mg 24 hours preoperatively or placebo. The primary outcome was the change in serum hs-cTn concentrations 24 hours after surgery. Secondary outcomes included the incidence of major adverse cardiovascular events (MACE; myocardial infarction, heart failure, stroke, or cardiovascular death) within seven days after surgery, as well as all-cause mortality and postoperative arrhythmia.

Results: A total of 112 patients with similar baseline characteristics were evenly randomized and completed a seven-day follow-up. Postoperative hs-cTn levels increased significantly in the placebo group (p < 0.001) but decreased in the statin group (p < 0.001), with a significant between-group difference favoring statin therapy (p < 0.001). Subgroup analyses by anesthesia type and prior statin use showed consistent findings. MACE occurred in three patients (5.4%) in the statin group and three patients (5.4%) in the placebo group (p = 1.000).

Conclusions: Preoperative high-dose atorvastatin significantly reduced postoperative hs-cTn, indicating a biochemical cardioprotective effect, but did not translate into a reduction of short-term clinical cardiovascular events. Larger multicenter trials with longer follow-up are required to determine whether troponin reduction translates into improved clinical outcomes.