Efficacy of Different Perioperative Statin Regimens on the Protection Against Post Coronary Artery Bypass Grafting Major Adverse Cardio-cerebral Events

This study was conducted at the National Heart Institute (NHI), Cairo, Egypt, during the period between June 2013 and February 2015. It was approved by the ethics committee at the Faculty of Pharmacy, Cairo University, and the scientific committee at the NHI. An informed consent was obtained from all study participants after they have been approached with the nature, purpose and possible risks of the study.

Preoperative baseline demographic characteristics, preoperative medications, comorbid conditions and risk factors were identified and summarized.

Design: This is a randomized, prospective, interventional, open label study. Upon admission to the NHI, eligible patients were randomly assigned to one of 3 treatment groups; group I (80 mg atorvastatin/day for 2 days preoperatively), group II (40 mg atorvastatin/day for 5-9 days preoperatively) or group III (80 mg atorvastatin/day for 5-9 days preoperatively). Atorvastatin doses were reinitiated postoperatively as soon as patients could take the medication orally and was continued for one month after operation.

The following intra-operative data were recorded for each patient; cardiopulmonary bypass time, aortic clamp time, type of anesthesia, number of grafts and need for blood transfusion.

Blood samples were drawn preoperatively (baseline) then at 8 hours, 24 hours, 48 hours postoperatively and before hospital discharge. Blood samples were spun and sera were separated, stored according to the storage conditions specified by the manufacturer, and used to measure the TnI, CK-MB and CRP at the time of analysis. Cardiac TnI was assayed by the Dimension® TNI method, a homogenous sandwich chemiluminescent assay based on LOCI® technology, using SIEMENS Dimension® EXL™, LOCI® Module system. Siemens Healthcare Diagnostics Inc. Newark, USA. CK-MB isoenzyme was measured by the Mass MMB method, a one-step enzyme immunoassay based on the sandwich principle, using SIEMENS Dimension® Heterogeneous Immunoassay Module system. Siemens Healthcare Diagnostics Inc. Newark, USA. CRP was measured by the C-Reactive Protein Extended Range (RCRP) method, a method based on a particle enhanced turbidimetric immunoassay (PETIA) technique, using SIEMENS Dimension® system. Siemens Healthcare Diagnostics Inc. Newark, USA.