Congress Reports

American College of Cardiology
55th Annual Scientific Session
March 11-14, Atlanta
 
 
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ARMYDA-3: Atorvastatin pre-treatment reduces post-surgical atrial fibrillation

The Atorvastatin for Reduction of Myocardial Dysrhythmia After cardiac surgery (ARMYDA-3) study is the first randomized trial to indicate that pre-treatment with a statin reduces new onset post-operative atrial fibrillation (AF) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), independent of confounding factors. Multivariate analysis showed a 60% risk reduction in AF. Further, hospital lengths of stay were significantly shorter in the atorvastatin arm. Dr. Germano Di Sciascio, Campus Bio-Medico University of Rome in Italy, presented the trial at the American College of Cardiology meeting.

In ARMYDA-3, 323 consecutive patients undergoing elective heart surgery with CPB were randomized to either atorvastatin 40 mg/day (n=101) or placebo (n=99) before surgery. Blood samples for CRP were taken before surgery, and every 24 hours after surgery until the patient was discharged.

The patients were 66 years old on average, and 68%-79% were male. Medical history included diabetes in 42% and 32% in the placebo and atorvastatin groups respectively, hypercholesterolemia in 20%, and prior MI in 38%-47%. Left ventricular ejection fraction was 52%.

The primary endpoint of incidence of post-operative in hospital AF > 5 minutes, registered on continuous telemetry monitoring or on 12-lead EC, was reduced from 57% in the placebo group to 35% in the atorvastatin group (p=0.003).

The time to AF onset was 51.5 hours with atorvastatin and 50 hours with placebo (p=0.59). With atorvastatin, the length of hospital stay was 6.3 days compared to 6.9 days with placebo (p=0.001).

CRP levels, a secondary endpoint, were higher in patients who had AF (about 180 mg/dL with AF vs about 120-130 mg/dL without AF; p=0.01). For the secondary endpoint of major adverse cardiovascular events at 30-days, death occurred in 2 patients in both groups; MI in 3 patients in each group; revascularization was nearly zero; and stroke occurred in 1 patients in the placebo group.

 
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