Mariscalco Giovanni, Lorusso Roberto, Klersy Catherine, Ferrarese Sandro, Tozzi Matteo, Vanoli Davide, Domenico Bruno Vito, Sala Andrea
Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
Ann Thorac Surg. 2007 Oct;84(4):1158-64. doi: 10.1016/j.athoracsur.2007.05.021.
Recent evidence supports the important role of inflammation in atrial fibrillation (AF) after coronary artery bypass grafting (CABG) and there is growing evidence that statin has cardiac antiarrhythmic effects. The aim of this study was to assess the efficacy of preoperative statins in preventing AF after CABG in a longitudinal observational study.
Over a two-year period, 405 consecutive patients underwent isolated CABG procedures. Univariate analysis was performed exploring the relationship regarding statin use and AF development. A propensity score for treatment with statins was obtained from core patient characteristics. The role of statin therapy on postoperative AF was assessed by means of a conditional logistic model, while stratifying on the quintiles of the propensity score. All analysis was performed retrospectively.
Postoperative AF occurred in 29.5% of the patients with preoperative statin therapy compared with 40.9% of those patients without it (p = 0.021). No statistical differences among development of AF and type, dose, or duration of preoperative statin therapy were observed. Preoperative statins were associated with a 42% reduction in risk of AF development after CABG surgery (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.91, p = 0.017, while stratifying on the propensity score). No different effect of statins on AF was observed with respect to age groups (< or = 70 and > 70 years) (interaction p = 0.711).
Preoperative statins may reduce postoperative AF after CABG. Patients undergoing elective revascularization may benefit from a preventive statin approach.
近期证据支持炎症在冠状动脉旁路移植术（CABG）后房颤（AF）中起重要作用，且越来越多证据表明他汀类药物具有心脏抗心律失常作用。本纵向观察性研究的目的是评估术前使用他汀类药物预防CABG术后房颤的疗效。
在两年期间，405例连续患者接受了单纯CABG手术。进行单因素分析以探讨他汀类药物使用与房颤发生之间的关系。从核心患者特征中获得他汀类药物治疗的倾向评分。通过条件逻辑模型评估他汀类药物治疗对术后房颤的作用，同时根据倾向评分的五分位数进行分层。所有分析均为回顾性。
术前接受他汀类药物治疗的患者中，29.5%发生术后房颤，而未接受治疗的患者中这一比例为40.9%（p = 0.021）。未观察到房颤发生与术前他汀类药物治疗的类型、剂量或持续时间之间存在统计学差异。术前使用他汀类药物与CABG手术后房颤发生风险降低42%相关（比值比[OR] 0.58，95%置信区间[CI] 0.37至0.91，p = 0.017，根据倾向评分分层）。在不同年龄组（≤70岁和>70岁）中，未观察到他汀类药物对房颤有不同影响（交互作用p = 0.711）。
术前使用他汀类药物可能降低CABG术后房颤的发生率。接受择期血运重建的患者可能从预防性他汀类药物治疗中获益。
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