Perioperative statin administration with decreased risk of postoperative atrial fibrillation, but not acute kidney injury or myocardial infarction: A meta-analysis

Li Zhen-Han,Zhou Xiao-Li,Chen Dan,Shi Rui,Wu Qing-Chen,Feng Bo

doi:10.1038/s41598-017-10600-x

Abstract

A controversy effect of perioperative statin use for preventing postoperative atrial fibrillation (POAF) and acute kidney injury (AKI) after cardiac surgery still remains. We thus performed current systematic review and meta-analysis to comprehensively evaluate effects of statin in cardiac surgery. 22 RCTs involving 5243 patients were included. Meta-analysis of 18 randomized controlled trials with 3995 participants suggested that perioperative statin use could decrease the risk of POAF (relative risk [RR] 0.69, 95%CI 0.56 to 0.86, P = 0.001), with a moderate heterogeneity (I2 = 65.7%, PH < 0.001). And the beneficial effect was found only in patients receiving coronary artery bypass graft (CABG), but not in patients undergoing valve surgery. However, perioperative statin use was not associated with lower risks of AKI (RR 0.98, 95%CI 0.70 to 1.35, P = 0.884, I2 = 33.9%, PH = 0.157) or myocardial infarction (MI) (RR 0.84, 95%CI 0.58 to 1.23, P = 0.380, I2 = 0%, PH = 0.765), and even an increased trend of AKI was observed in patients with valve surgery. Perioperative statin use could decrease the inflammation response with no impact on clinical outcomes. In conclusion, perioperative statin use is useful in preventing POAF, particularly in patients with CABG, and ameliorate inflammation, while it has no effect on AKI and MI after cardiac surgery.

Highlights

Despite advanced protection of cardiopulmonary bypass (CPB) and other techniques supported during cardiac surgery, the major post-operation complications are still like Pandora’s Box, contributing to the substantial mortality and morbidity and increasing medical costs[1, 2]
Our meta-analysis, included 22 randomized controlled trials (RCTs) consisting of 5243 participants, found that perioperative statin use could significantly decrease the incidence of postoperative atrial fibrillation (POAF), and the beneficial effect was associated with surgery type, statin type and statin doses
While it failed to reduce the incidence of acute kidney injury (AKI) and myocardial infarction (MI), and the null association remained consistent in most subgroup and sensitivity analyses

Summary

Introduction

Despite advanced protection of cardiopulmonary bypass (CPB) and other techniques supported during cardiac surgery, the major post-operation complications are still like Pandora’s Box, contributing to the substantial mortality and morbidity and increasing medical costs[1, 2]. Researches demonstrated that these complications were mainly driven by post-perfusion syndrome, oxidative stress and release of inflammation cytokines after cardiac surgery[3, 4]. Observational studies, randomized controlled trials (RCTs), and meta-analysis have demonstrated that perioperative statin use could decrease the incidence of POAF and AKI7–10, and latest guidelines suggested statins should be administrated in all patients undergoing coronary artery bypass graft (CABG) except for specific contradictions[11]. We further systematically summarized current evidence of RCTs and meta-analyses to provide a www.nature.com/scientificreports/. Comprehensive evaluation and try to answer the following questions in patients without chronic statin use: 1) verify the association between perioperative statin use and POAF, and clarify the impact of related factors on the association; 2) whether statin could decrease the incidence of AKI, and the effect of other related factors on the association between perioperative statin use and AKI after surgery; 3) the effect of perioperative statin use on other clinical outcomes and biochemical indexes

Methods

Results

Conclusion