Preoperative Statin Therapy for Atrial Fibrillation and Renal Failure after Cardiac Surgery Elmar W. Kuhn 1 Oliver J. Liakopoulos 1 Yeong-Hoon Choi 1 Parwis Rahmanian 1 Kaveh Eghbalzadeh 1 Ingo Slottosch 1 Antje Christin Deppe 1 Thorsten C.W. Wahlers 1 1 Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany Thorac Cardiovasc Surg Address for correspondence Elmar W. Kuhn, MD, Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Str. 62, Cologne 50937, Germany (e-mail: elmar.kuhn@uk-koeln.de). Introduction Cardiac surgical procedures aim to improve patients’ health status but simultaneously incorporate a relevant risk for the development of postoperative complications. 1 While the overall mortality for on- or off-pump procedures has stabi- lized at around 3 to 4% worldwide, the continually aging patient population with a high prevalence of relevant comor- bidities shows postoperative complication rates ranging from 5 to 15% depending on the risk cohort. 1,2 In this context, perioperative treatment with hydroxymethylglutaryl-coen- zyme A reductase inhibitors (statins) has been identified as a promising approach to improve postoperative outcomes of patients undergoing cardiac surgery through lipid-lowering actions and additional pleiotropic effects. 3 Keywords ► cardiac surgery ► statin therapy ► adverse outcomes ► systematic review ► meta-analysis Abstract Background Performing cardiac surgery in patients with cardiovascular risk factors incorporates a steady risk for the development of postoperative complications. Perioperative statin intake was associated with an improvement of perioperative outcomes in these patients. However, the European Association for Cardio-Thoracic Surgery guidelines regarding the perioperative statin treatment were changed recently due to large studies reporting about relevant adverse effects related to statin therapy. Methods All relevant databases were searched including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the metaRegister of Controlled Trials. Various registries were screened (National Research Register, the ClinicalTrials. gov, and gray literature) with search on online conference indices of relevant scientific meetings. No language restrictions were applied. Results We identified 10 randomized controlled studies summarizing 3,468 partic- ipants undergoing various kinds of cardiac surgical procedures. All included studies presented with marked differences regarding study design. Pooled analysis indicated that statin pretreatment was associated with a formally reduced incidence of postop- erative atrial fibrillation (AF) (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.39–1.00; p ¼ 0.05) but with an increased incidence of renal failure (OR 1.20, 95% CI 1.01–1.44; p ¼ 0.04) compared with control. Substantial heterogeneity was ob- served among studies reporting about AF. Conclusion Current but sparse evidence reveals that statin pretreatment is associat- ed with a higher rate of postoperative renal failure compared with control therapy but is ineffective to substantially reduce postoperative AF. Given the relevant heterogeneity among included studies, statin pretreatment cannot be generally recommended. received June 22, 2019 accepted after revision March 16, 2020 © Georg Thieme Verlag KG Stuttgart · New York DOI https://doi.org/ 10.1055/s-0040-1710322. ISSN 0171-6425. Original Cardiovascular Downloaded by: Thieme E-Books & E-Journals. Copyrighted material. Published online: 2020-06-07