Effect of statins on atrial fibrillation after cardiac surgery: A duration- and dose-response meta-analysis
Objective This meta-analysis of randomized, controlled trials evaluated effects of statins on postoperative atrial fibrillation risk after cardiac surgery. Methods Randomized, controlled trials evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Regi...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2010-08, Vol.140 (2), p.364-372 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Chen, Wendy T., PharmD Krishnan, Guru M., MD Sood, Nitesh, MD Kluger, Jeffrey, MD Coleman, Craig I., PharmD |
| description | Objective This meta-analysis of randomized, controlled trials evaluated effects of statins on postoperative atrial fibrillation risk after cardiac surgery. Methods Randomized, controlled trials evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Register, and manual review of references without any language restrictions. End points examined included postoperative atrial fibrillation, intensive care unit stay, and total hospital stay. Meta-regression analyses were conducted to determine whether statins' effects were duration or dose dependent. A random-effects model was used in all instances. Results Eight trials (n = 774) were identified and subjected to meta-analysis. Statins reduced postoperative atrial fibrillation risk (relative risk 0.57, 95% confidence interval 0.45–0.72, P |
| doi_str_mv | 10.1016/j.jtcvs.2010.02.042 |
| format | Article |
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Methods Randomized, controlled trials evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Register, and manual review of references without any language restrictions. End points examined included postoperative atrial fibrillation, intensive care unit stay, and total hospital stay. Meta-regression analyses were conducted to determine whether statins' effects were duration or dose dependent. A random-effects model was used in all instances. Results Eight trials (n = 774) were identified and subjected to meta-analysis. Statins reduced postoperative atrial fibrillation risk (relative risk 0.57, 95% confidence interval 0.45–0.72, P < .0001, risk difference −0.14, 95% confidence interval −0.20 to −0.08, P < .0001, number needed to treat 8) and total hospital stay (weighted mean difference −0.66 days, 95% confidence interval −1.01 to −0.30 days, P = .0004) relative to placebo. Intensive care unit stay was also reduced (weighted mean difference −0.17 days, 95% confidence interval −0.37 to 0.03 days, P = .09) but did not meet prespecified criteria for statistical significance. Metaregression analysis revealed association between duration of preoperative statin prophylaxis and postoperative atrial fibrillation risk reduction (3% reduction per day, P = .008). No association was found between statin dose used and risk reduction ( P = .47). Conclusions Evidence suggests that statins are associated with reduced risk of postoperative atrial fibrillation and shorter hospital stay after cardiac surgery and that earlier therapy results in more profound benefit.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2010.02.042</identifier><identifier>PMID: 20381820</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Arrhythmia Agents - administration & dosage ; Atrial Fibrillation - etiology ; Atrial Fibrillation - prevention & control ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiac Surgical Procedures - adverse effects ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Critical Care ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Evidence-Based Medicine ; Female ; Heart ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2010-08, Vol.140 (2), p.364-372</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2010 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c554t-926a8d8c5221b5b1f0e0864b30b2282e0ef973f64d6a38eb52143f26a643b4ef3</citedby><cites>FETCH-LOGICAL-c554t-926a8d8c5221b5b1f0e0864b30b2282e0ef973f64d6a38eb52143f26a643b4ef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2010.02.042$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23059759$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20381820$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Wendy T., PharmD</creatorcontrib><creatorcontrib>Krishnan, Guru M., MD</creatorcontrib><creatorcontrib>Sood, Nitesh, MD</creatorcontrib><creatorcontrib>Kluger, Jeffrey, MD</creatorcontrib><creatorcontrib>Coleman, Craig I., PharmD</creatorcontrib><title>Effect of statins on atrial fibrillation after cardiac surgery: A duration- and dose-response meta-analysis</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective This meta-analysis of randomized, controlled trials evaluated effects of statins on postoperative atrial fibrillation risk after cardiac surgery. Methods Randomized, controlled trials evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Register, and manual review of references without any language restrictions. End points examined included postoperative atrial fibrillation, intensive care unit stay, and total hospital stay. Meta-regression analyses were conducted to determine whether statins' effects were duration or dose dependent. A random-effects model was used in all instances. Results Eight trials (n = 774) were identified and subjected to meta-analysis. Statins reduced postoperative atrial fibrillation risk (relative risk 0.57, 95% confidence interval 0.45–0.72, P < .0001, risk difference −0.14, 95% confidence interval −0.20 to −0.08, P < .0001, number needed to treat 8) and total hospital stay (weighted mean difference −0.66 days, 95% confidence interval −1.01 to −0.30 days, P = .0004) relative to placebo. Intensive care unit stay was also reduced (weighted mean difference −0.17 days, 95% confidence interval −0.37 to 0.03 days, P = .09) but did not meet prespecified criteria for statistical significance. Metaregression analysis revealed association between duration of preoperative statin prophylaxis and postoperative atrial fibrillation risk reduction (3% reduction per day, P = .008). No association was found between statin dose used and risk reduction ( P = .47). Conclusions Evidence suggests that statins are associated with reduced risk of postoperative atrial fibrillation and shorter hospital stay after cardiac surgery and that earlier therapy results in more profound benefit.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Arrhythmia Agents - administration & dosage</subject><subject>Atrial Fibrillation - etiology</subject><subject>Atrial Fibrillation - prevention & control</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Critical Care</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk2LFDEQhoMo7rj6CwTJRTz1WEn6Iy0oLMuuCgseVPAW0umKpLene0ylF-bfm96ZVfDiKaF43krlSRh7KWArQNRvh-2Q3B1tJeQKyC2U8hHbCGibotbVj8dsAyBlUUmpztgzogEAGhDtU3YmQWmhJWzY7ZX36BKfPadkU5iIzxO3KQY7ch-6GMYxl9eaTxi5s7EP1nFa4k-Mh3f8gvdLvCcKbqee9zNhEZH280TId5hsYSc7HijQc_bE25HwxWk9Z9-vr75dfipuvnz8fHlxU7iqKlPRytrqXrs8uOiqTnhA0HXZKeik1BIBfdsoX5d9bZXGrpKiVD6H6lJ1JXp1zt4c--7j_GtBSmYXyGG-yITzQqZRqm11qyGT6ki6OBNF9GYfw87GgxFgVslmMPeSzSrZgDRZck69OvVfuh32fzIPVjPw-gRYcnb00U4u0F9OQdU2VZu590cOs427gNGQCzg57EPMj2L6OfxnkA__5N0YppCPvMUD0jAvMasnIwzlgPm6_of1OwhYd3WtfgNtbbDS</recordid><startdate>20100801</startdate><enddate>20100801</enddate><creator>Chen, Wendy T., PharmD</creator><creator>Krishnan, Guru M., MD</creator><creator>Sood, Nitesh, MD</creator><creator>Kluger, Jeffrey, MD</creator><creator>Coleman, Craig I., PharmD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100801</creationdate><title>Effect of statins on atrial fibrillation after cardiac surgery: A duration- and dose-response meta-analysis</title><author>Chen, Wendy T., PharmD ; Krishnan, Guru M., MD ; Sood, Nitesh, MD ; Kluger, Jeffrey, MD ; Coleman, Craig I., PharmD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c554t-926a8d8c5221b5b1f0e0864b30b2282e0ef973f64d6a38eb52143f26a643b4ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Arrhythmia Agents - administration & dosage</topic><topic>Atrial Fibrillation - etiology</topic><topic>Atrial Fibrillation - prevention & control</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Critical Care</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Wendy T., PharmD</creatorcontrib><creatorcontrib>Krishnan, Guru M., MD</creatorcontrib><creatorcontrib>Sood, Nitesh, MD</creatorcontrib><creatorcontrib>Kluger, Jeffrey, MD</creatorcontrib><creatorcontrib>Coleman, Craig I., PharmD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Wendy T., PharmD</au><au>Krishnan, Guru M., MD</au><au>Sood, Nitesh, MD</au><au>Kluger, Jeffrey, MD</au><au>Coleman, Craig I., PharmD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of statins on atrial fibrillation after cardiac surgery: A duration- and dose-response meta-analysis</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2010-08-01</date><risdate>2010</risdate><volume>140</volume><issue>2</issue><spage>364</spage><epage>372</epage><pages>364-372</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective This meta-analysis of randomized, controlled trials evaluated effects of statins on postoperative atrial fibrillation risk after cardiac surgery. Methods Randomized, controlled trials evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Register, and manual review of references without any language restrictions. End points examined included postoperative atrial fibrillation, intensive care unit stay, and total hospital stay. Meta-regression analyses were conducted to determine whether statins' effects were duration or dose dependent. A random-effects model was used in all instances. Results Eight trials (n = 774) were identified and subjected to meta-analysis. Statins reduced postoperative atrial fibrillation risk (relative risk 0.57, 95% confidence interval 0.45–0.72, P < .0001, risk difference −0.14, 95% confidence interval −0.20 to −0.08, P < .0001, number needed to treat 8) and total hospital stay (weighted mean difference −0.66 days, 95% confidence interval −1.01 to −0.30 days, P = .0004) relative to placebo. Intensive care unit stay was also reduced (weighted mean difference −0.17 days, 95% confidence interval −0.37 to 0.03 days, P = .09) but did not meet prespecified criteria for statistical significance. Metaregression analysis revealed association between duration of preoperative statin prophylaxis and postoperative atrial fibrillation risk reduction (3% reduction per day, P = .008). No association was found between statin dose used and risk reduction ( P = .47). Conclusions Evidence suggests that statins are associated with reduced risk of postoperative atrial fibrillation and shorter hospital stay after cardiac surgery and that earlier therapy results in more profound benefit.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>20381820</pmid><doi>10.1016/j.jtcvs.2010.02.042</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Arrhythmia Agents - administration & dosage Atrial Fibrillation - etiology Atrial Fibrillation - prevention & control Biological and medical sciences Cardiac dysrhythmias Cardiac Surgical Procedures - adverse effects Cardiology. Vascular system Cardiothoracic Surgery Critical Care Dose-Response Relationship, Drug Drug Administration Schedule Evidence-Based Medicine Female Heart Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Length of Stay Male Medical sciences Middle Aged Pneumology Randomized Controlled Trials as Topic Risk Assessment Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Time Factors Treatment Outcome |
| title | Effect of statins on atrial fibrillation after cardiac surgery: A duration- and dose-response meta-analysis |
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