Published Online
on September 25, 2006

A more recent version of this article appeared on October 3, 2006

This Article Full Text (PDF) CME: Take the course for this article: Circulation: October 3, 2006, Volume 114, Number 14 All Versions of this Article: 114/14/1455    most recent CIRCULATIONAHA.106.621763v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager patientINFORMation Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patti, G. Articles by Di Sciascio, G. Search for Related Content PubMed PubMed Citation Articles by Patti, G. Articles by Di Sciascio, G. Related Collections Arrhythmias, clinical electrophysiology, drugs CV surgery: coronary artery disease CV surgery: valvular disease Related Article

Submitted on February 17, 2006
Revised on July 23, 2006
Accepted on August 7, 2006

Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery. Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study

Giuseppe Patti MD, Massimo Chello MD, Dario Candura MD, Vincenzo Pasceri MD, Andrea D’Ambrosio MD, Elvio Covino MD, and Germano Di Sciascio MD^*

From the Department of Cardiovascular Sciences (G.P., M.C., D.C., A.D., E.C., G.D.S.), Campus Bio-Medico University, Rome, Italy, and Interventional Cardiology (V.P.), S. Filippo Neri Hospital, Rome, Italy.

^* To whom correspondence should be addressed. E-mail: g.disciascio{at}unicampus.it.

Background--Atrial fibrillation (AF) after cardiac surgery is associated with increased risk of complications, length of stay, and cost of care. Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF. We tested this observation in a randomized, controlled trial.

Methods and Results--Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass, without previous statin treatment or history of AF, were enrolled. Patients were randomized to atorvastatin (40 mg/d, n=101) or placebo (n=99) starting 7 days before operation. The primary end point was incidence of postoperative AF; secondary end points were length of stay, 30-day major adverse cardiac and cerebrovascular events, and postoperative C-reactive protein (CRP) variations. Atorvastatin significantly reduced the incidence of AF versus placebo (35% versus 57%, P=0.003). Accordingly, length of stay was longer in the placebo versus atorvastatin arm (6.9±1.4 versus 6.3±1.2 days, P=0.001). Peak CRP levels were lower in patients without AF (P=0.01), irrespective of randomization assignment. Multivariable analysis showed that atorvastatin treatment conferred a 61% reduction in risk of AF (odds ratio 0.39, 95% confidence interval 0.18 to 0.85, P=0.017), whereas high postoperative CRP levels were associated with increased risk (odds ratio 2.0, 95% confidence interval 1.2 to 7.0, P=0.01). The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms.

Conclusions--Treatment with atorvastatin 40 mg/d, initiated 7 days before surgery, significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay. These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery.

Key words: thoracic surgery • trials • statins • atrial fibrillation

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