SOURCE: Zheng Z, Jayaram R, Jiang L, et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med 2016;374:1744-1753.

Based on favorable effect on surrogate markers such as C-reactive protein, as well as small clinical trials that suggested reduced incidence of perioperative atrial fibrillation and other complications, guidelines have endorsed administration of perioperative statin therapy. The Statin Therapy in Cardiac Surgery trial was designed to provide more definitive information.

Patients undergoing elective cardiac surgery (n = 1,922) were randomized to perioperative rosuvastatin 20 mg/d or placebo. The primary outcomes were atrial fibrillation and myocardial infarction within five days of surgery.

As has been previously demonstrated, rosuvastatin treatment reduced low-density lipoprotein levels and C-reactive protein. However, there was no difference in the incidence of atrial fibrillation or myocardial infarction.

Of concern, there was an increased risk for acute kidney injury in the rosuvastatin group; within the first 48 hours postoperatively, the frequency of acute injury of any severity was 24.7% in the rosuvastatin arm vs. 19.3% in the placebo arm. Fortunately, most of the acute kidney injury incurred was stage one (mild intensity).

Despite early data suggesting benefits of perioperative statin treatment, this larger data set fails to confirm benefit and indicates some potential harm.