Observational study on the beneficial effect of preoperative statins in reducing atrial fibrillation after coronary surgery
Observational study on the beneficial effect of preoperative statins in reducing atrial fibrillation after coronary surgery
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DOI：
10.1016/j.athoracsur.2007.05.021
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发表时间：
2007-10-01
影响因子：
4.6
通讯作者：
Sala, Andrea
中科院分区：
文献类型：
--
作者：
Mariscalco, Giovanni;Lorusso, Roberto;Sala, Andrea
背景。最近的证据支持炎症在冠状动脉旁路移植术（CABG）后房颤（AF）中的重要作用，并且越来越多的证据表明他汀类药物具有抗心律失常的作用。本研究的目的是在一项纵向观察研究中评估术前他汀类药物预防冠脉搭桥后房颤的疗效。在两年的时间里，连续405例患者接受了孤立的CABG手术。单因素分析探讨他汀类药物使用与房颤发生的关系。从核心患者特征中获得了他汀类药物治疗的倾向评分。他汀类药物治疗对术后房颤的作用通过条件logistic模型进行评估，同时对倾向评分的五分位数进行分层。所有分析均为回顾性分析。术前接受他汀类药物治疗的患者术后房颤发生率为29.5%，而未接受他汀类药物治疗的患者术后房颤发生率为40.9% （p = 0.021）。房颤的发生与术前他汀类药物治疗的类型、剂量或持续时间没有统计学差异。术前使用他汀类药物与冠脉搭桥术后房颤发生风险降低42%相关（优势比[OR] 0.58, 95%可信区间[CI] 0.37至0.91,p = 0.017，并对倾向评分进行分层）。不同年龄组（70岁）他汀类药物对房颤的影响无差异（相互作用p = 0.711）。术前他汀类药物可减少冠脉搭桥术后房颤。接受选择性血运重建术的患者可能受益于预防性他汀类药物治疗。
Background. 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.Methods. 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.Results. 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 ( 70 years) ( interaction p = 0.711).Conclusions. Preoperative statins may reduce postoperative AF after CABG. Patients undergoing elective revascularization may benefit from a preventive statin approach.