The Effect of High-Dose Atorvastatin on Postoperative Troponin in Patients Undergoing Non-Cardiac Surgery: A...

Preoperative administration of high-dose statins in patients undergoing non-cardiac surgery reduced postoperative troponin.

Cardiovascular complications account for a substantial proportion of perioperative complications. This study aimed to evaluate whether preoperative high-dose atorvastatin reduces postoperative changes in serum high-sensitivity cardiac troponin (hscTn) concentrations in patients at elevated cardiac risk undergoing noncardiac surgery.

In this triple-blind, parallel-group, randomized controlled trial, adults with a Revised Cardiac Risk Index (RCRI) of 1 or greater scheduled for noncardiac surgery were randomized (1:1) to receive atorvastatin 80 mg 24 hours preoperatively or placebo. The primary outcome was the change in serum hs-cTn concentrations 24 hours after surgery. Secondary outcomes included the incidence of major adverse cardiovascular events (MACE) within 7 days after surgery, as well as cardiovascular death, myocardial infarction, stroke, heart failure, arrhythmia, or transient ischemic attack.

A total of 112 patients with similar baseline characteristics were randomized and completed a 7-day follow-up. Postoperative hs-cTn levels increased significantly in the placebo group (P<0.001) but decreased in the statin group (P<0.001), with a significant between-group difference favoring statin therapy (P<0.001). Subgroup analyses by anesthesia type and prior statin use showed consistent findings. MACE occurred in three patients (5.4%) in the statin group and two patients (3.6%) in the placebo group (P=1.00).

Preoperative high-dose atorvastatin significantly reduced postoperative hs-cTn levels, indicating a biochemical cardioprotective effect, but it did not translate into a reduction of short-term clinical cardiovascular events. Larger multicenter trials with longer follow-up are required to determine whether troponin reduction translates into improved clinical outcomes.