Abstract 2863: Do Thiazolidinediones or Statins Suppress Post-Cardiothoracic Surgery Atrial Fibrillation in Diabetics?
Background: In a recent clinical trial, statins reduced post-cardiothoracic surgery (CTS) atrial fibrillation (AF), probably through an anti-inflammatory mechanism. Thiazolidinediones (TZDs) suppress inflammation as well. We sought to determine if TZDs or statins could further reduce the incidence of post-CTS AF in a diabetic population treated aggressively with beta-blockers and prophylactic amiodarone.
Methods: All diabetic patients who underwent CTS from the randomized, controlled Atrial Fibrillation Suppression Trials I, II and III (AFIST I, II and III) were evaluated in this nested study. Patient demographics, surgical characteristics, medication utilization and the incidence of post-CTS AF (AF > 5 minutes duration) were uniformly and prospectively collected as part of AFIST I, II and III. Multivariate logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals.
Results: The population (n = 184) averaged 66.9 ± 7.3 years of age, 71.7% were male, 7.1% underwent valve surgery, 4.9% had prior AF, 17.9% had heart failure and 84% and 42% received postoperative beta-blockade and prophylactic amiodarone, respectively. Forty patients (21.7%) received a preoperative TZD while 120 patients (65.2%) were treated preoperatively with a statin. In total, 66 patients (35.9%) developed post-CTS AF, 13 patients (32.5%) while being on a TZD and 38 patients (31.6%) while treated preoperatively with a statin. Upon multivariate logistic regression, statin use was associated with a reduction in post-CTS AF [adjusted odds ratio: 0.46 (95%CI 0.23 to 0.93)] whereas TZD use was not [adjusted odds ratio: 0.80 (95%CI 0.32 to 1.99)]. The independent predictors of post-CTS AF are provided in the table⇓.
Conclusions: In a population with significant beta-blocker and prophylactic amiodarone use, adjunctive statin use was associated with a reduction in a patient’s odds of developing post-CTS AF but TZD use was not.