Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Hellenic J Cardiol. 2019 Jan-Feb;60(1):40-47. doi: 10.1016/j.hjc.2017.12.012. Epub 2018 Jan 4.
Observational studies have suggested that statins might reduce postoperative atrial fibrillation (AF) in patients undergoing cardiac surgery. However, a number of retrospective studies have shown equivocal results. We aimed to evaluate whether different statins can reduce the risk for AF at different doses.
We searched PubMed, EMBASE, and the Cochrane Database for all published randomized controlled trials (RCTs) that examined the effects of statin therapy on AF up to June 2016. A random-effects model was used when there was substantial heterogeneity.
Eighteen published studies that included 4003 statin-naive patients (2009 receiving satins and 1994 receiving regime) with sinus rhythm before cardiac surgeries were identified for inclusion in the analysis. Thirteen studies investigated the prevention of AF by atorvastatin, two studies investigated the prevention of AF by rosuvastatin, two studies investigated the prevention of AF by simvastatin, and one study investigated the prevention of AF by pravastatin. The remaining two studies compared the effects of different doses of atorvastatin on the prevention of AF in patients undergoing coronary artery bypass grafting (CABG). Overall, statin therapy was associated with a significant decrease in the risk for AF (relative risk [RR]: 0.57, 95% confidence interval [CI]: 0.45-0.73, P = 0.000). However, subgroup analyses showed that only atorvastatin reduced the risk for new-onset AF in patients after cardiac surgery (RR: 0.53, 95% CI: 0.41-0.69, P = 0.000). Patients undergoing CABG possibly received more benefits from statin therapy (RR: 0.52, 95% CI: 0.39-0.68).Statin therapy in a moderate dose may be optimal (RR: 0.42, 95% CI: 0.28-0.64).
This meta-analysis suggests that statin therapy has an overall protective effect against postoperative AF, among which atorvastatin in a moderate dose was significantly associated with a decreased risk for new-onset AF in patients after CABG. Moreover, simvastatin may also exert a significant protective effect against the AF recurrences in patients undergoing cardiac surgeries; hence, further prospective studies are warranted.
观察性研究表明他汀类药物可能降低心脏手术患者的术后心房颤动（AF）风险。然而，一些回顾性研究结果并不一致。我们旨在评估不同剂量的他汀类药物是否可以降低 AF 的风险。
我们检索了 PubMed、EMBASE 和 Cochrane 数据库，以获取截至 2016 年 6 月所有发表的他汀类药物治疗对 AF 影响的随机对照试验（RCT）。当存在显著异质性时，使用随机效应模型。
共纳入 18 项研究，包括 4003 例术前窦性心律的他汀类药物初治患者（2009 例接受他汀类药物治疗，1994 例接受常规治疗）。13 项研究探讨了阿托伐他汀预防 AF 的作用，2 项研究探讨了瑞舒伐他汀预防 AF 的作用，2 项研究探讨了辛伐他汀预防 AF 的作用，1 项研究探讨了普伐他汀预防 AF 的作用。其余 2 项研究比较了不同剂量阿托伐他汀对冠状动脉旁路移植术（CABG）患者预防 AF 的影响。总体而言，他汀类药物治疗与 AF 风险降低显著相关（相对风险 [RR]：0.57，95%置信区间 [CI]：0.45-0.73，P=0.000）。然而，亚组分析显示，只有阿托伐他汀可降低心脏手术后新发 AF 的风险（RR：0.53，95% CI：0.41-0.69，P=0.000）。接受 CABG 的患者可能从他汀类药物治疗中获益更多（RR：0.52，95% CI：0.39-0.68）。中等剂量的他汀类药物治疗可能是最佳选择（RR：0.42，95% CI：0.28-0.64）。
这项荟萃分析表明，他汀类药物治疗对术后 AF 具有总体保护作用，其中中等剂量的阿托伐他汀与 CABG 后新发 AF 的风险降低显著相关。此外，辛伐他汀也可能对心脏手术患者的 AF 复发有显著的保护作用；因此，需要进一步进行前瞻性研究。
