Postoperative Myocardial Injury and Inflammation is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients. Issue 1 (February 2018)

• Record Type: Journal Article
• Authors: Bass, Anne R.; Szymonifka, Jackie D.; Rondina, Matthew T.; Bogardus, Margaret; Scott, Mitchell G.; Woller, Scott C.; Stevens, Scott M.; Eby, Charles; Merritt, Kerri; Valle, Alejandro Gonzalez Della; Moskowitz, Gerard; Flores, Eva; Gage, Brian F.
• Is Part Of: HSS journal. Volume 14:Issue 1(2018)
• Page Start: 67
• Page End: 76
• Publication Date: 2018-02
• Subjects: troponin -- orthopedics -- inflammation -- interleukin-6 -- C-reactive protein -- myocardial ischemia; Musculoskeletal system -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; Musculoskeletal System -- surgery -- Periodicals; Orthopedic Procedures -- Periodicals; Orthopédie -- Périodiques; Appareil locomoteur -- Maladies -- Périodiques; Appareil locomoteur -- Maladies -- Patients -- Réadaptation -- Périodiques; 617.47005
• DOI: 10.1007/s11420-017-9577-1
• Languages: English
• ISSNs: 1556-3316

Abstract

Background: Orthopedic patients are at risk for adverse postoperative cardiovascular outcomes. Questions/Purposes: This pilot randomized controlled trial (RCT) of atorvastatin vs. placebo in orthopedic surgery patients was performed in order to assess: (1) the prevalence of perioperative myocardial injury; (2) the effect of atorvastatin on perioperative inflammation; and (3) the feasibility of performing a large RCT of statin therapy in orthopedic patients. Methods: Hip fracture (hip Fx) and total hip and knee replacement (THR and TKR) patients were randomized 1:1 to atorvastatin 40 mg daily vs. placebo, starting preoperatively and continuing until postoperative day (POD) 45. High-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured preoperatively and on POD 2. Patients were monitored for adverse events until POD 90. Results: Five hundred fifty-six patients were screened, 22 were recruited (4 hip Fx, 11 THR, 7 TKR), and 2 withdrew. Most (80%) had detectable hs-cTnI (> 1.1 pg/mL) preoperatively. Twenty percent had a perioperative rise in hs-cTnI (≥ 10 pg/mL), which was not blunted by atorvastatin. Hs-CRP rose in 19/20 patients, and IL-6 rose in all patients. However, atorvastatin did not blunt the rise in these inflammatory biomarkers. On POD 2, IL-6 and hs-cTnI levels correlated ( ρ = 0.59, p = 0.02). Recruitment was limited by the high prevalence of statin use in the screened population and a high prevalence of exclusions among hip fracture patients. Conclusion: Perioperative myocardial injury and inflammation are common in orthopedic patients and do not appear to be reduced in those randomized to atorvastatin. Trial Registration: NCT02197065