No Beneficial Effect of Perioperative Rosuvastatin in Patients Undergoing Cardiac Surgery

Authors: Zheng Z et al., N Engl J Med 2016 May 5; 374:1744

This approach did not decrease the incidence of postoperative atrial fibrillation or perioperative myocardial damage.

Cardiac surgery has shown many recent advances, but postoperative complications in patients undergoing bypass surgery remain a challenge. Investigators in China evaluated the effectiveness of perioperative rosuvastatin (20 mg/day) versus placebo in 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery. Perioperative treatment began up to 8 days before surgery and lasted until 5 days afterwards.

Postoperative atrial fibrillation within 5 days of surgery, a prespecified coprimary outcome, was detected in 21% of the rosuvastatin group and 20% of the placebo group, a nonsignificant difference. In any of the nine prespecified subgroups (e.g., age ≤60 vs. >60, male vs. female, procedure, operative technique, postoperative medications), rosuvastatin again did not lower the incidence of postoperative atrial fibrillation. Rosuvastatin also did not affect the other coprimary outcome, perioperative myocardial injury, or secondary outcomes related to myocardial injury. Acute kidney injury was significantly more common with rosuvastatin than with placebo. The two groups showed no significant differences in the rates of recorded postsurgical serious adverse events.

Comment Although previous small studies yielded positive results, perioperative rosuvastatin therapy in this larger, placebo-controlled trial did not lower incidence of postoperative atrial fibrillation or perioperative myocardial damage. The search continues for strategies to limit postoperative atrial fibrillation and myocardial damage. Moderate-to-intense statin therapy is still recommended for patients with coronary atherosclerosis.