Comparison of Frequency of New-Onset Atrial Fibrillation or Flutter in Patients on Statins Versus Not on Statins Presenting With Suspected Acute Coronary Syndrome

doi:10.1016/j.amjcard.2007.03.034

The American Journal of Cardiology

Volume 100, Issue 3, 1 August 2007, Pages 404-405

https://doi.org/10.1016/j.amjcard.2007.03.034 Get rights and content

The effect of statins on the incidence of new-onset atrial fibrillation (AF) in patients presenting with suspicion of acute coronary syndrome (ACS) is unknown. Our study population consisted of patients admitted to a tertiary care Veterans Administration hospital with suspicion of ACS between November 2001 and January 2006. All patients had an electrocardiogram on admission that was compared with a previous electrocardiogram to confirm new-onset AF or atrial flutter. Of 1,526 patients, 164 (10.8%) had new-onset AF and 601 (39.4%) were on a statin on admission. Patients with AF were significantly more likely to be older, Caucasian, have renal insufficiency and anemia, and less likely to be diabetic, on a statin or angiotensin-converting enzyme inhibitor on admission, or have chest pain as a presenting complaint. In univariate analysis, patients on statins were significantly less likely to have new-onset AF (odds ratio 0.40, 95% confidence interval 0.33 to 0.69, p <0.01). This relation persisted in the multivariate model (odds ratio 0.57, 95% confidence interval 0.39 to 0.83, p <0.01) after correcting for age, race, diabetes mellitus, chest pain, and use of angiotensin-converting enzyme inhibitor. In conclusion, patients presenting with suspicion of ACS were much less likely to have newonset AF if they were on a statin at time of presentation.

Section snippets

Methods and Results

This study was approved by the institutional review board of the Veterans Administration Pittsburgh Healthcare System (Pittsburgh, Pennsylvania). The study population is from an ongoing registry of ACSs and is described elsewhere.² Briefly, the population consists of patients admitted to monitored beds at the Veterans Administration hospital with suspected ACS/NSTEMI between January 2001 and April 2006.³ Clinical information including laboratory data and patient history were determined by chart

Discussion

Our study shows that use of statins appears to be associated with a significantly lower risk of new-onset AF in patients presenting with suspected ACS/NSTEMI, a finding consistent with previous observations that statins appear to play a beneficial role in the prevention of AF.4, 5, 6, 7 Although this correlation has been assessed in postsurgical patients, after cardioversion in lone AF, and in patients with left ventricular dysfunction, it has not been studied in patients presenting with an

Refrences (9)

R.H. Mehta et al.
Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation
Am J Cardiol
(2003)
M. Zahid et al.
Effect of both elevated troponin I and peripheral white blood cell count on prognosis in patients with suspected myocardial injury
Am J Cardiol
(2005)
C.P. Cannon et al.
American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromesA report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee)
J Am Coll Cardiol
(2001)
Y. Young-Xu et al.
Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease
Am J Cardiol
(2003)

There are more references available in the full text version of this article.

Cited by (40)

Prior statin use and the incidence of in-hospital arrhythmia in acute coronary syndrome: A systematic review and meta-analysis
2023, Indian Heart Journal
The benefit of prior statin use to reduce the incidence of arrhythmia in acute coronary syndrome (ACS) is still a matter of debate. Statins have multiple pleiotropic effects, which may reduce the incidence of in-hospital arrhythmia. A systematic review and meta-analysis were performed to evaluate prior statin use and the incidence of in-hospital arrhythmia in ACS.
This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We performed a literature search through Pubmed, Proquest, EBSCOhost, and Clinicaltrial.gov. A random-effect model was used due to moderate heterogeneity. Quality assessment was performed using Newcastle Ottawa Scale. Sensitivity analysis was performed by using leave one or two out method. PROSPERO registration number: CRD42022336402.
Nine eligible studies consisting of 86,795 patients were included. A total of 22,130 (25.5%) patients were in statin use before the index ACS event. The prevalence of old myocardial infarction, heart failure, hypertension, diabetes mellitus, and chronic renal failure and concomitant treatment with aspirin, clopidogrel, and beta blocker was higher in the prior statin group compared to no previous statin. Overall, prior statin use was associated with a significantly lower incidence of in-hospital arrhythmia during ACS compared to no previous statin (OR 0.60; 95% CI 0.49–0.72; P < 0.00001; I² = 54%, P-heterogeneity = 0.03). In subgroup analysis, previous statin use reduced the incidence of atrial fibrillation or atrial flutter (OR 0.64; 95% CI 0.43–0.95; P = 0.03; I² = 73%, P-heterogeneity = 0.01) and ventricular tachycardia or ventricular fibrillation (OR 0.57; 95% CI 0.49–0.65; P < 0.00001; I² = 8%, P-heterogeneity = 0.35).
Based on aggregate patient data, prior statin use may reduce the incidence of in-hospital arrhythmia during ACS, particularly atrial fibrillation or atrial flutter and ventricular tachycardia or ventricular fibrillation.
Efficacy of atorvastatin in prevention of atrial fibrillation after heart valve surgery in the PROFACE trial (PROphylaxis of postoperative atrial Fibrillation after Cardiac surgEry)
2016, Journal of Arrhythmia
To evaluate the efficacy of perioperative atorvastatin administration for prophylaxis of postoperative atrial fibrillation (POAF) after heart valve surgery.
Our study included 90 patients with heart valve disease who were scheduled to undergo elective cardiac surgery. Cases with previous AF or preoperative beta-blocker therapy were excluded. Patients were randomized into the atorvastatin group, which included 47 patients who received 40 mg/day of atorvastatin 7 days before and after the surgery and the control group, which included 43 patients. Primary endpoint was the occurrence of POAF. Secondary endpoints included modifications in the preoperative and postoperative levels of the markers of inflammation (C-reactive protein [CRP]), myocardial injury (ultrasensitive troponin T and creatinine phosphokinase MB [CPK-MB]), and cardiac dysfunction (pro-brain natriuretic peptide [proBNP]) related to POAF and changes in the echocardiographic parameters, such as atrial electromechanical interval, A wave, E/A ratio, and Doppler imaging systolic velocity wave amplitude, related to POAF.
No relationship between atorvastatin administration and reduction in the incidence of POAF was observed (42.6% in the atorvastatin vs. 30.2% in the control group) (p=0.226). No difference in the levels of CPK-MB, ultrasensitive troponin T, CRP, or proBNP and in the analyzed echocardiographic parameter was detected between both groups.
Atorvastatin in the described dose, was not adequate for the prophylaxis of POAF after heart valve surgery. It was ineffective in controlling the inflammatory phenomena, myocardial injury, and echocardiographic predictors of POAF.
Association between the use of renin-angiotensin system blockers and development of in-hospital atrial fibrillation in patients with ST-segment elevation myocardial infarction
2016, Medicina (Lithuania)
Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). We evaluated the association between use of previous angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers (renin-angiotensin system [RAS] blockers) and started RAS blockers after MI and development of AF in patients presenting with acute STEMI.
This retrospective study enrolled 1000 patients with acute STEMI who were admitted to the coronary care unit. Patients were divided into groups according to the use of RAS blockers before MI and development of AF rates was compared. Predictors of AF were determined by multiple logistic regression analysis.
Of the 1000 patients presenting with STEMI, 247 received and 753 did not receive RAS blockers. The incidence of AF was 7.9%. The incidence of AF in patients receiving RAS blockers and did not receiving RAS blockers before MI were similar (5.7% vs. 8.6% respectively, P = 0.13). On the other hand, AF rate was lower in patients in whom RAS blockers were administered during MI as compared to those in whom these agents were not administered (7.2% vs. 28.6%, P < 0.001). Multiple regression analysis results showed that administration of RAS blockers or statins during hospitalization and left atrial diameter were associated with development of AF in patients with acute STEMI.
Previous therapy with RAS blockers does not reduce the incidence of AF in STEMI. Administration of RAS blockers at the hospital may decrease the AF rate in STEMI.
Statin therapy lowers the risk of new-onset atrial fibrillation in patients with end-stage renal disease
2015, International Journal of Cardiology
Citation Excerpt :
In patients with stable CAD, statin seems to be protective against AF [20], but the evidence is not strong. Stronger evidence is present in patients with acute coronary syndrome [48–52]. Numerous studies showed that statin therapy, given either before or after acute coronary syndrome, might decrease the incidence of new onset AF [48–52].
The objective is to assess the effectiveness of statin use to prevent atrial fibrillation (AF) in dialysis patients.
We used a database from the Registry for Catastrophic Illness from the National Health Research Institute (NHRI), which encompasses almost 100% of the patients receiving dialysis started from 1997 to 2008 in Taiwan. All dialysis patients aged 18 or older without history of cardiovascular events in 1997 and 1998 were incorporated. Finally, 113,191 dialysis patients were enrolled. We used propensity score (PS) matching method and Cox's proportional hazard regression models to estimate hazard ratios for AF events for statin users vs. nonusers.
In statin group, the incidence of developing new AF was significantly lower than that in control group (1.1% vs. 3.8%, P < 0.001). The PS-based selection process identified 2146 patients receiving statins and 2146 who did not receive statins. The incidence of developing AF remained lower in statin group than that in control group (2.4% vs. 4.9%, P < 0.001). After PS matching, Cox's proportional hazard regression analyses showed that there was a protective effect of developing AF in a dose-responsive manner. The protective effect was more obvious in subjects with younger age, female gender, hyperlipidemia, coronary artery disease and peripheral artery disease and in subjects without taking angiotensin converting enzyme inhibitor and angiotensin receptor blocker.
Our analyses showed that statin therapy was associated with lower risk of newly diagnosed AF in patients with dialysis.
The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions: A systematic review and meta-analysis
2013, International Journal of Cardiology
Previous meta-analyses suggest that pre-procedural use of statin therapy may reduce atrial fibrillation (AF) following invasive cardiac interventions (coronary artery by-pass grafting and percutaneous coronary intervention). However, the current evidence on the benefit of statins unrelated to invasive cardiac interventions has not been clarified systematically.
Through a systematic literature search, trials examining the effect of statin therapy on AF were selected. Trials using statins before any percutaneous or surgical cardiac interventions were excluded.
The search identified 11 randomized and 16 observational eligible studies, totaling 106,640 patients receiving statin therapy and 129,305 serving as controls. Fourteen studies investigated the effect of statins on new-onset AF, 13 studies investigated the effect of statins on recurrent AF and one in both new-onset and recurrent AF. In the statin versus control group the mean age was 60.7 ± 8.3 versus 68.6 ± 6.2 years and females comprised 8.4% versus 10.3%. Statin therapy was associated with significant reduction of AF (Risk ratio (RR): 0.81 [95% confidence interval (CI): 0.80–0.83], p < 0.001) combining all studies. Assessing exclusively randomized trials, statin therapy showed no significant risk reduction (RR: 0.97 [95%CI: 0.90–1.05], p = 0.509), heterogeneity p > 0.05. Assessing exclusively observational studies the risk reduction of new-onset AF was 12% (RR: 0.88 [95%CI: 0.85-0.91], p < 0.001) and recurrent AF 15% (RR: 0.85 [95%CI: 0.80–0.90], p < 0.001), heterogeneity p < 0.001.
The hitherto published randomized clinical trials do not support a beneficial effect of statins on AF in patients not undergoing invasive cardiac interventions. This is in contrast to the results of observational and interventional studies.
Statin therapy is beneficial for the prevention of atrial fibrillation in patients with coronary artery disease: A meta-analysis
2013, European Journal of Pharmacology
Citation Excerpt :
After reading the full texts of the articles, 21 references were excluded, as 2 references were non-English language, 4 references were studies of extensive or long-term statin therapy compared to traditional statin therapy, 2 references had original data unavailable for extraction, 10 references had coronary artery bypass grafting patients as study subjects, and 3 references were excluded because they were duplicated publications with shorter follow-up periods. Consequently, 10 observational cohort studies (Ramani et al., 2007; Vedre et al., 2009; Danchin et al., 2010; Dziewierz et al., 2010; Ozaydin et al., 2010; Young-Xu et al., 2003a, 2003b; Pellegrini et al., 2009; Kulik et al., 2010; Bang et al., 2011) were included in the final analysis (Fig. 1). Among the ten included references, 8 references were full-text and the other 2 were abstracts.
The ability of statins to prevent atrial fibrillation (AF) in coronary artery disease (CAD) patients is controversial. To elucidate this problem, we conducted a meta-analysis. Electronic databases were searched through October 2011 to identify relevant studies. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Data extraction and meta-analysis were conducted using standard methods. The meta-analysis was performed with data derived from 10 cohort studies of the effects of statins on atrial fibrillation. The endpoint used was the occurrence or new onset of AF. A total of 193,839 patients were included, and 87,741 (45.26%) patients received statin therapy. The occurrence of AF was decreased by 35% in the statin therapy group compared to the non-statin-treated group (95% confidence interval: 0.57–0.74; P<0.001) with a heterogeneity of 86.2%. Subgroup analysis and sensitivity analysis were also performed to explore the source of heterogeneity and to test the stability of the results, and the subgroup results did not materially alter the conclusion. There was no significant publication bias according to Begg's and Egger's tests (Begg, p=0.21; Egger, p=0.71). Therefore, statin therapy is beneficial for preventing atrial fibrillation in patients with coronary artery disease.

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Coronary artery diseaseComparison of Frequency of New-Onset Atrial Fibrillation or Flutter in Patients on Statins Versus Not on Statins Presenting With Suspected Acute Coronary Syndrome

Section snippets

Methods and Results

Discussion

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Coronary artery disease
Comparison of Frequency of New-Onset Atrial Fibrillation or Flutter in Patients on Statins Versus Not on Statins Presenting With Suspected Acute Coronary Syndrome