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Comparative Effects of Different Statin Regimens on Postoperative Outcomes in Isolated Coronary Artery Bypass
Osman Fehmi Beyazal1, Zeki Temizturk1, Cemalettin Aydin1
1Department of Cardiovascular Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
Insights
Preoperative statin use, specifically atorvastatin or rosuvastatin, significantly reduced new-onset atrial fibrillation after coronary artery bypass grafting (CABG). Statin dosage did not impact postoperative outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a major cardiac surgery.
- Postoperative atrial fibrillation (POAF) is a common complication following CABG.
- The role of preoperative statin therapy in mitigating POAF and other outcomes remains an area of investigation.
Purpose of the Study:
- To evaluate the impact of preoperative statin type and dosage on early postoperative outcomes after isolated CABG.
- To compare outcomes between statin-naive patients and those on atorvastatin or rosuvastatin.
- To assess dose-dependent effects of atorvastatin on postoperative results.
Main Methods:
- Retrospective analysis of 950 patients undergoing isolated CABG.
- Stratification into statin-naive, atorvastatin, and rosuvastatin groups.
- Propensity score matching used to compare low-to-moderate vs. high-dose atorvastatin regimens.
Main Results:
- New-onset atrial fibrillation (NOAF) incidence was significantly higher in statin-naive patients (18.4%) compared to atorvastatin (11.9%) and rosuvastatin (10.8%) users (p=0.02).
- No significant differences in NOAF or other early postoperative outcomes were observed between atorvastatin and rosuvastatin groups.
- No significant differences in postoperative outcomes were found between low-to-moderate and high-dose atorvastatin groups.
Conclusions:
- Preoperative use of atorvastatin or rosuvastatin is associated with a reduced incidence of NOAF after isolated CABG.
- Statin type (atorvastatin vs. rosuvastatin) and atorvastatin dosage did not significantly influence early postoperative outcomes, including NOAF.
- Preoperative statin therapy is an independent protective factor against NOAF in CABG patients.
Abstract:
Background: This study aimed to evaluate the impact of various preoperative statin types and dosage regimens on early postoperative outcomes following isolated coronary artery bypass grafting (CABG). Methods: A total of 950 patients who underwent isolated CABG between 2022 and 2026 were evaluated and stratified into three groups based on their preoperative statin status: Group A, statin-naive patients (n = 592); Group B, atorvastatin users (n = 293); and Group C, rosuvastatin users (n = 65). To analyze the dose-dependent outcomes of statins, patients in Group B were subsequently segregated into two subgroups and matched using propensity score matching: Group 3, low-to-moderate regimen (≤20 mg/day; n = 75), and Group 4, high-dose regimen (>20 mg/day; n = 75). Results: Except for the higher incidence of diabetes mellitus and hypertension in statin-treated patients, all pre- and intraoperative characteristics of Groups A, B, and C were similar, and all of their postoperative outcomes except new-onset atrial fibrillation (NOAF) were similar. NOAF incidence was significantly higher in statin-naive patients compared to both the atorvastatin and rosuvastatin cohorts [109 (18.4%) - 35 (11.9%) - 7 (10.8%), p = 0.02]. All early postoperative outcomes-including in-hospital mortality and NOAF incidence-were found to be fully similar between Groups 3 and 4. Furthermore, multivariable analysis confirmed preoperative statin use as an independent protective factor against NOAF. Conclusions: The preoperative utilization of either atorvastatin or rosuvastatin was associated with a lower NOAF incidence in isolated CABG, and no significant differences were observed between the atorvastatin and rosuvastatin cohorts regarding NOAF and other postoperative outcomes. Preoperative atorvastatin administration at doses below and above 20 mg/day showed no significant differences in terms of postoperative outcomes.