Impact of Preoperative Statin Augmentation on Myocardial Injury Assessed by Biomarkers and Strain Parameters in Off-Pump Coronary Artery Bypass Grafting

TL;DR

This study shows that giving a high dose of rosuvastatin before heart surgery helps protect the heart and improves recovery in patients already taking statins.

Contribution

The study demonstrates that preoperative high-dose rosuvastatin improves myocardial protection in chronic statin users undergoing OPCABG.

Findings

The loaded group had significantly lower postoperative cardiac biomarker levels at all time points.

The loaded group showed better global left ventricular strain recovery 48 hours post-surgery.

Preoperative high-dose rosuvastatin was associated with a lower incidence of postoperative atrial fibrillation.

Abstract

Background:Myocardial injury is common after off-pump coronary artery bypass grafting (OPCABG). Statins exert cardioprotection against ischemia/reperfusion injury through diverse pathways. We aimed to assess whether preoperative high-dose statin therapy enhances cardioprotection against ischemia/reperfusion injury in chronic statin users undergoing OPCABG.

Methods: In this parallel-group non-randomized observational study, patients receiving chronic statin therapy for more than 30 days were included, regardless of the type or dosage of statin used. Patients were assigned either to a rosuvastatin-loaded group (single dose of 40 mg, administered orally seven days before surgery) or to a comparator control group without any loading. Cardiac biomarkers, including troponin I (TnI), creatine kinase-MB (CK-MB), and N-terminal pro B-type natriuretic peptide (NT-proBNP), were assessed preoperatively and at 8, 24, and 48 hours after surgery. Global left ventricular strains (circumferential (GCS), longitudinal (GLS), and radial (GRS)) were evaluated preoperatively and at 48 hours and 30 days postoperatively.

Results: In this exploratory analysis, the loaded group showed significantly lower postoperative cardiac biomarker levels at all time points. All global left ventricular strains (GLS, GCS, and GRS) declined 48 hours post-surgery, but were significantly better in the loaded group. Global strains recovered until 30 days post-surgery, with higher recovery seen in the loaded group. Postoperative atrial fibrillation (AF) occurred less frequently in the loaded group (8% versus 24%, p = 0.001). On multivariable analysis, 48-hour GCS independently predicted poor postoperative left ventricular ejection fraction (LVEF) (≤50%) at 30 days. Receiver operating characteristic (ROC) analysis identified 48-hour GRS < 26.5% as the best predictor of poor postoperative LVEF (≤50%) at 30 days, with 89.5% sensitivity and 71.0% specificity.

Conclusion: Preoperative high-dose rosuvastatin confers significant cardioprotection in chronic statin users undergoing OPCABG, as reflected by reduced biomarker release, enhanced myocardial strain recovery, and lower incidence of atrial fibrillation. The observed association between statin loading and improved myocardial performance warrants confirmation in larger prospective studies.

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