Comparison of effects of atorvastatin and rosuvastatin in the prevention of atrial fibrillation in patients undergoing coronary artery bypass graft

Abstract

Coronary artery bypass grafting (CABG) is an important treatment for ischemic heart diseases and in different groups of patients it prolongs survival, relieves angina and improves quality of life. One of the most common complications after CABG is the incidence of supraventricular arrhythmias such as atrial fibrillation (AF) and atrial flutter. The prevalence of AF in various studies has been reported between 10% and 50%. Also, high ventricular rate and loss of atrial contraction can disrupt systemic hemodynamics and increase the risk of embolism which can lead to increasing in the length of hospital stay and need for intensive care. Statins, are one of the treatments used to prevent AF after CABG. In addition to lipid-lowering effects, these drugs also have anti-inflammatory effects, and given that systemic inflammatory markers before surgery are one of the possible mechanisms of AF after CABG; In some studies, statins have reduced the incidence of AF after CABG. Considering lack of clinical trial comparing the effects of rosuvastatine and atorvastatin in preventing the frequency of AF after CABG, this study was designed and performed to compare the effect of these drugs on the frequency of AF after CABG. Patients and Methods: This is a double-blind clinical trial study was. 200 people who were candidates for CABG Elective in Shahid Madani Hospital in Tabriz, were randomly divided into two groups of 100 people in each group using a computer program. Atorvastatin 40 mg / day for one group and rosuvastatin 20 mg / day for the other group were administered from one week before CABG, and these individuals underwent Holter monitoring for 48 hours postoperatively in the ICU. In order to compare the frequency of AF, hospitalization and ICU length of stay and mortality rate in the two groups, the conditions for both groups were compared. Results: 100 patients were in the rosuvastatine group and 100 patients were in the atorvastatin group. The mean age of the first group was 59.30±8.42 and the second group was 9.40 ± 60.13 (p=0.58) and the two groups were not significantly different in terms of other indicators affecting AF and CABG process. The results of this study showed that there was no significant difference in the incidence of AF in the study groups. Twenty-seven patients (27%) in the rosuvastatine group and 31 (31%) patients in the atorvastatin group developed AF after CABG surgery, which the difference was not statistically significant. (p = 0.53). The mean time interval between CABG and the incidence of AF in patients in the rosuvastatine group was 25.93 ± 13.37 hours and in the atorvastatin, group was 25.43 ± 12.35 hours, which was not significantly different (p = 0.90). Also, the duration of AF in patients did not show a significant difference between the two groups (219.43±206.29 minutes in the rosuvastatine group and 174.97±397.08 minutes in the atorvastatin group; p =0.68). The duration of hospitalization was 11.62 ± 3.62 days in the rosuvastatine group and 11.21±3.06 days in the atorvastatin group, but no significant difference was observed between the two groups (p = 0.42). The length of hospital and intensive care unit (ICU) stay was 4.41±1.27 in the rosuvastatine group and 5.07 ± 4.54 in the atorvastatin group, which was not statistically significant (p=0.24). Two patients in the atorvastatin group and two patients in the rosuvastatine group lost their lives, and the study was not associated with significant side effects.