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Bass AR, Szymonifka JD, Rondina MT, et al. Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients. HSS J. 2017;14(1):67-76doi: 10.1007/s11420-017-9577-1.
Bass, A. R., Szymonifka, J. D., Rondina, M. T., Bogardus, M., Scott, M. G., Woller, S. C., Stevens, S. M., Eby, C., Merritt, K., Valle, A. G. D., Moskowitz, G., Flores, E., & Gage, B. F. (2018). Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 14(1), 67-76. https://doi.org/10.1007/s11420-017-9577-1
Bass, Anne R, et al. "Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients." HSS journal : the musculoskeletal journal of Hospital for Special Surgery vol. 14,1 (2018): 67-76. doi: https://doi.org/10.1007/s11420-017-9577-1
Bass AR, Szymonifka JD, Rondina MT, Bogardus M, Scott MG, Woller SC, Stevens SM, Eby C, Merritt K, Valle AGD, Moskowitz G, Flores E, Gage BF. Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients. HSS J. 2018 Feb;14(1):67-76. doi: 10.1007/s11420-017-9577-1. Epub 2017 Oct 13. PMID: 29398998; PMCID: PMC5786589.
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HSS J. 2018 Feb;14(1):67-76. doi: 10.1007/s11420-017-9577-1. Epub 2017 Oct 13.

Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients.

HSS journal : the musculoskeletal journal of Hospital for Special Surgery

Anne R Bass, Jackie D Szymonifka, Matthew T Rondina, Margaret Bogardus, Mitchell G Scott, Scott C Woller, Scott M Stevens, Charles Eby, Kerri Merritt, Alejandro Gonzalez Della Valle, Gerard Moskowitz, Eva Flores, Brian F Gage

Affiliations

  1. 1Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
  2. 7Weill Cornell Medicine, New York, NY 10065 USA.
  3. 2The University of Utah, Salt Lake City, UT USA.
  4. 3Columbia University College of Physicians & Surgeons, New York City, NY USA.
  5. 4Washington University School of Medicine, St. Louis, MO USA.
  6. 5Intermountain Healthcare, Murray, UT USA.
  7. 6New York Presbyterian Hospital, New York City, NY USA.

PMID: 29398998 PMCID: PMC5786589 DOI: 10.1007/s11420-017-9577-1

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 (

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.

Keywords: C-reactive protein; inflammation; interleukin-6; myocardial ischemia; orthopedics; troponin

Conflict of interest statement

Compliance with Ethical StandardsJaclyn D. Szymonifka, MA; Matthew T. Rondina, MD, MS; Margaret Bogardus, BA; Scott C. Woller, MD; Scott M. Stevens, MD; Kerri Merritt; Gerard Moskowitz, PhD; Alejandro

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