The impact of statins on post-discharge atrial fibrillation after cardiac surgery: Secondary analysis from a randomized trial
Hibino et al.
CJC Open
2022/12/29
Abstract
Background
Whether statins reliably reduce the risk of post-operative atrial fibrillation (POAF) in patients undergoing cardiac surgery remains controversial. We sought to determine the impact of statin use on new-onset post-discharge POAF in the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial.
Methods
We randomized 336 patients with risk factors for stroke (CHA2DS2-VASc score≥2) and no history of preoperative AF to 30-day continuous cardiac rhythm monitoring after discharge from cardiac surgery with a wearable, patched-based device or to usual care. The primary endpoint was the occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram within 30 days of randomization.
Results
The 260 (77.4%) patients who were discharged on statins were more likely to be male (p=0.018) and had lower CHA2DS2-VASc scores (p=0.011). Patients treated with statins at discharge had a 2-fold lower rate of POAF than those who were not treated with statins in the entire cohort (18.4% vs. 8.1%, Log-Rank p=0.0076). On multivariable Cox regression including the CHA2DS2-VASc score adjustment, statin use was associated with a lower risk of POAF (hazard ratio 0.43, 95% CI 0.25-0.98, p=0.043). Use of statins at a higher intensity was associated with lower risk of POAF, suggestive of a dose-response (Log-Rank ptrend=0.0082).
Conclusion
The use of statins was associated with a reduction in post-discharge POAF risk among patients undergoing cardiac surgery. The routine use of high-intensity statin to prevent sub-acute POAF after discharge deserves further study.