Lee Yeiwon, Im Somin, Kang Yoonjin, Sohn Suk Ho, Jang Myoung-Jin, Hwang Ho Young
Department of Critical Care, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Acute Crit Care. 2024 Nov;39(4):507-516. doi: 10.4266/acc.2024.00633. Epub 2024 Nov 25.
This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).
Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger's test.
Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40-80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27-0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment.
Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.
本荟萃分析旨在评估高强度他汀类药物治疗对冠状动脉旁路移植术（CABG）后新发术后房颤（POAF）的影响。
检索四个数据库，查找纳入接受CABG患者并研究围手术期使用高强度他汀类药物对POAF发生率影响的研究。主要结局是POAF的发生率。次要结局是手术死亡率和围手术期心肌梗死（PMI）。使用漏斗图和Egger检验评估发表偏倚。
选择了9篇文章（8项随机对照试验和1项非随机研究：n = 3,072）。4项研究使用瑞舒伐他汀（20 mg），另外5项研究使用阿托伐他汀（40 - 80 mg）。纳入研究中报道的POAF发生率在11%至48.8%之间。汇总分析显示，接受高强度他汀类药物治疗的患者POAF发生率显著低于对照组患者（优势比，0.43；95%置信区间，0.27 - 0.68；P < 0.001）。亚组分析显示，高强度他汀类药物的影响在使用阿托伐他汀的研究中显著，但在使用瑞舒伐他汀的研究中不显著。使用安慰剂的研究与使用低剂量他汀类药物的研究在主要终点上没有显著亚组差异。包括手术死亡率和PMI发生率在内的次要结局不受高强度他汀类药物治疗的影响。
围手术期使用高强度他汀类药物与接受CABG患者的POAF发生率降低57%相关。
