Lertsburapa Kirkeith, White C Michael, Kluger Jeffrey, Faheem Osman, Hammond Jonathon, Coleman Craig I
Henry Low Heart Center, Hartford Hospital, Hartford, Conn, USA.
J Thorac Cardiovasc Surg. 2008 Feb;135(2):405-11. doi: 10.1016/j.jtcvs.2007.08.049.
Recent studies have suggested that statins reduce atrial fibrillation after cardiothoracic surgery, but the use of proven prophylactic strategies such as beta-blockers and amiodarone in these studies was not provided. Therefore, we sought to determine whether preoperative statin use could reduce the incidence of post-cardiothoracic surgery atrial fibrillation in a population who already had a high background use of beta-blockers and appreciable use of prophylactic amiodarone.
Patients undergoing cardiothoracic surgery from the randomized, controlled Atrial Fibrillation Suppression Trials I, II, and III were evaluated in this nested cohort evaluation. The patients' demographics, surgical characteristics, medication use, and incidence of post-cardiothoracic surgery atrial fibrillation (atrial fibrillation > 5 minutes duration) were uniformly and prospectively collected as part of Atrial Fibrillation Suppression Trials I, II, and III. Multivariate logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals.
Overall, 331 patients (59.6%) received a statin preoperatively and 224 patients (40.4%) did not. The study population had an average age of 67.8 +/- 8.6 years, 77.1% were male, 14.6% had valve surgery, 6.1% had a history of atrial fibrillation, 12.6% had a history of heart failure, 84.0% received postoperative beta-blockade, and 44.1% received postoperative prophylactic amiodarone. In total, 174 patients (31.4%) developed post-cardiothoracic surgery atrial fibrillation. Upon multivariate logistic regression, statin use was associated with a reduction in post-cardiothoracic surgery atrial fibrillation (adjusted odds ratio: 0.60; 95% confidence interval 0.37-0.99). Higher intensity statin dosing (equivalent of > or = 40 mg of atorvastatin) seemed to be associated with the greatest reductions in post-cardiothoracic surgery atrial fibrillation (adjusted odds ratio: 0.45; 95% confidence interval 0.21-0.99).
In a population with appreciable beta-blocker and amiodarone use, adjunctive preoperative statin use was still associated with a 40% reduction in patients' odds of developing post-cardiothoracic surgery atrial fibrillation.
近期研究表明，他汀类药物可降低心胸外科手术后房颤的发生率，但这些研究未采用如β受体阻滞剂和胺碘酮等已证实的预防策略。因此，我们试图确定在已有高比例使用β受体阻滞剂背景且预防性使用胺碘酮比例可观的人群中，术前使用他汀类药物是否能降低心胸外科手术后房颤的发生率。
在这项巢式队列评估中，对来自房颤抑制试验I、II和III这三项随机对照试验中接受心胸外科手术的患者进行了评估。作为房颤抑制试验I、II和III的一部分，统一且前瞻性地收集了患者的人口统计学资料、手术特征、用药情况以及心胸外科手术后房颤（持续时间>5分钟的房颤）的发生率。采用多因素逻辑回归计算调整后的比值比及95%置信区间。
总体而言，331例患者（59.6%）术前接受了他汀类药物治疗，224例患者（40.4%）未接受。研究人群的平均年龄为67.8±8.6岁，77.1%为男性，14.6 %接受瓣膜手术，6.1%有房颤病史，12.6%有心力衰竭病史，84.0%术后接受了β受体阻滞剂治疗，44.1%术后接受了预防性胺碘酮治疗。共有174例患者（31.4%）发生了心胸外科手术后房颤。经多因素逻辑回归分析，使用他汀类药物与心胸外科手术后房颤发生率降低相关（调整后的比值比：0.
