Preoperative statins as modifiers of cardiac and inflammatory outcomes following coronary artery bypass graft surgery: a meta-analysis

Abstract

Early postoperative cardiac complications of coronary artery bypass graft surgery, such as atrial fibrillation (AF) or myocardial infarction (MI), may be beneficially modulated by preoperative statins, involving their anti-inflammatory effects. There is uncertainty on the clinical merit of statin pretreatment. Addressing this, we conducted a meta-analysis of early cardiac complications and inflammatory markers following statin pretreatment in coronary artery bypass graft surgery. A search of Medline and Cochrane databases was undertaken to identify suitable studies. A meta-analysis was carried out for early cardiac (AF, MI, myocardial injury markers) and inflammatory (cytokines, C-reactive protein) outcomes. We identified 17 suitable studies that featured data from the total of 2796 patients. Twelve studies (1260 treated and 1263 untreated patients) reported AF incidence. Statin pretreatment was associated with a significant decrease of AF incidence: odds ratio 0.44 (95% confidence interval: 0.27-0.70; P = 0.003). Seven studies (381 treated and 277 untreated patients) reported useful data on MI. Unlike in AF, no significant modulation of postoperative MI in association with statin pretreatment could be observed: odds ratio 0.62 (95% confidence interval: 0.21-1.81; P = 0.62). Five studies (248 treated and 245 untreated patients) provided data on postoperative rise of C-reactive protein. This rise was significantly downregulated in statin-pretreated patients: standardized mean difference -0.44 (95% confidence interval: -0.78 to -0.11; P = 0.02). Thus, postoperative AF incidence is the biggest beneficiary of statin pretreatment in coronary artery bypass graft surgery. This effect is associated with beneficial modulation of systemic inflammatory markers.

Keywords: Atrial fibrillation; C-reactive protein; Coronary artery bypass; Hydroxymethylglutaryl-CoA reductase inhibitors; Meta-analysis.