, Volume 8, Issue 3, pp 963-971
Date: 11 Nov 2011

Effects of Preoperative Short Term Use of Atorvastatin on Endothelial Progenitor Cells after Coronary Surgery: A Randomized, Controlled Trial

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Abstract

Objectives

We investigated the effects of short-term use of atorvastatin on CD34+/VEGF-R2+/CD133+/CD45- endothelial progenitor cell (EPC) count after on-pump coronary artery bypass surgery (CABG).

Methods

Between Feb-2010 and May-2010, we randomly assigned, in a placebo-controlled, double-blind study, 60 consecutive patients who underwent isolated, first-time CABG to receive either 14-day atorvastatin (40 mg/day) or placebo preoperatively. Urgent CABG and recent myocardial infarction were excluded. EPCs were quantified (cells/μl) by flow cytometric phenotyping obtained from venous blood samples collected preoperatively (T1), 6-hours (T2), and on the 5th day postoperatively (T3). Levels of markers of inflammation and serum cardiac troponin I were also measured preoperatively and daily until day-5 after surgery.

Results

There were no differences in baseline risk factors including cholesterol profiles, and EuroSCORES between the groups. The composite primary end-point, favored statin group with higher amount of circulating, early EPC count (cells/μl) at all time points compared with placebo (T1, 2.30 ± 0.02 versus 1.58 ± 0.03, p < 0.001; T2, 5.00 ± 0.06 versus 2.19 ± 0.06, p < 0.001; T3, 3.03 ± 0.08 versus 1.78 ± 0.02, p < 0.001). Postoperative hsCRP rise were inversely correlated with EPC count, and were significantly lower in the statin group (T1, 0.8 ± 0.1 versus 2.2 ± 1.5, p < 0.001; T2, 72.9 ± 3.2 versus 96.0 ± 3.6, p < 0.001; T3, 4.3 ± 1.2 versus 11.4 ± 4.1, p < 0.001). Furthermore, the incidence of postoperative atrial fibrillation was significantly lower in the statin group compared to placebo (3.3% versus 23%, p = 0.02).

Conclusions

Short-term atorvastatin use increases circulating early EPCs both pre- and post-operatively and is associated with better preservation of sinus rhythm and reduced hsCRP levels. (ClinicalTrials.gov number, NCT01096875)

Meeting Presentation: The Society of Thoracic Surgeons 47th Annual Meeting, San Diego, California, USA