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Clinical Investigations: CARDIOLOGY |

Statin Use Is Associated With a Reduction in Atrial Fibrillation After Noncardiac Thoracic Surgery Independent of C-Reactive Protein*

David Amar, MD; Hao Zhang, MD; Paul M. Heerdt, MD, PhD; Bernard Park, MD; Martin Fleisher, PhD; Howard T. Thaler, PhD
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*From the Departments of Anesthesiology and Critical Care Medicine (Drs. Amar, Zhang, and Heerdt), Clinical Laboratories (Dr. Fleisher), Surgery (Dr. Park), and Epidemiology and Biostatistics (Dr. Thaler), Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY.

Correspondence to: David Amar, MD, Director of Thoracic Anesthesia, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, M-304, New York, NY 10021; e-mail: amard@mskcc.org



Chest. 2005;128(5):3421-3427. doi:10.1378/chest.128.5.3421
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Study objectives: The level of C-reactive protein (CRP) has been shown to be elevated in patients with atrial fibrillation/flutter (AF) unrelated to surgery, and statins are known to lower the CRP level. To determine whether an elevated CRP level predisposes the patient to postoperative AF and whether statin use is associated with a reduced AF incidence, we studied a consecutive group of patients who were at risk for AF after undergoing thoracic surgery (age, ≥ 60 years).

Design and setting: A prospective study in a tertiary care cancer center of 131 patients (mean [± SD] age, 73 ± 6 years) who had undergone major lung or esophageal resection. High-sensitivity CRP and interleukin (IL)-6 levels were measured before surgery, on arrival at the postanesthesia care unit, and on the first morning after surgery. Continuous telemetry was used for 72 to 96 h to detect AF.

Results: AF occurred in 38 of 131 patients (29%) at a median time after surgery of 3 days. Although CRP and IL-6 levels increased significantly (p < 0.001) in response to surgery, patients with or without AF did not differ in perioperative values. In a stepwise logistic regression, statin use was associated with a threefold decrease in the odds of developing AF (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.08 to 0.82; p = 0.022) and a greater PR interval (OR, 1.11 per 5-ms increments; 95% CI, 1.01 to 1.22; p = 0.027) predicted an increase in the risk of AF.

Conclusions: The preoperative use of statins was associated with a protective effect against postoperative AF independent of CRP levels. In contrast to AF in the general population, early markers of inflammation did not predict the postoperative occurrence of AF.

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