Rosuvastatin Linked to Increase in Postoperative AKI

For patients undergoing heart surgery, treatment with rosuvastatin doesn’t reduce the rate of adverse outcomes, but is associated with an increased risk of postoperative acute kidney injury (AKI), according to a randomized trial in The New England Journal of Medicine.

The Statin Therapy in Cardiac Surgery (STICS) trial included 1922 patients undergoing elective coronary artery bypass grafting and/or aortic valve replacement. All were in sinus rhythm and not taking antiarrhythmic drugs. Patients were randomly assigned to receive rosuvastatin 20 mg/d or placebo, starting up to 8 days before surgery and continuing until 5 days afterward.

The 2 primary outcomes were atrial fibrillation developing within 5 days after surgery (based on Holter electrocardiographic monitoring) and myocardial injury developing within 120 hours (based on troponin T measurement). The wide range of secondary outcomes included AKI, based on Acute Kidney Injury Network criteria.

Postoperative atrial fibrillation occurred in 21% of patients in the rosuvastatin group and 20% in the placebo group. Troponin I release was also similar between groups; primary outcomes were no better with rosuvastatin in any patient subgroup.

Most secondary outcomes were also no different with rosuvastatin versus placebo. However, plasma creatinine increased to a greater extent with rosuvastatin, and remained elevated up to 5 days after surgery. Rates of any AKI at 48 hours were 24.7% with rosuvastatin and 19.3% with placebo. While most cases of AKI were stage 1, there was also a significant excess of stage 2 or 3 AKI (1.8 percentage points).

The STICS results question the recommendation to use perioperative statins to prevent atrial fibrillation and other complications after cardiac surgery. The findings also raise concern about an increased risk of AKI in patients assigned to rosuvastatin. The researchers write, “Given the lack of good evidence of beneficial effects of perioperative statin therapy…the adverse effects on renal function warrant careful consideration [Zheng Z, et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med 2016; 374:1744–1753].