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Recruiting NCT05076019

Statin Therapy With Atorvastatin in Surgical Aortic Valve Replacement

No phase Interventional Postoperative Atrial Fibrillation

For patients and families

In plain language

An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.

What is being studied
The protocol lists: Atorvastatin 80mg, Placebo.
Who it may be relevant to
Registry conditions: Postoperative Atrial Fibrillation. Basic parameters: 60 years — 95 years · All.
What needs checking
Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
Where it takes place
Denmark
Next step
Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →

Unsure about the terms? Read our patient guide →

Official title

Statin Therapy With Atorvastatin in Surgical Aortic Valve Replacement - a Randomized Controlled Trial

Overview

Statins have rapid and significant actions that have potentially important (but not yet proven) implications for postoperative atrial fibrillation and cardiac protection in patients undergoing cardiac surgery. The focus of this study is, therefore, on patients having surgical aortic valve replacement (with aortotomy) and the development of postoperative atrial fibrillation (POAF). Our aims are: to examine the ability of a clinically durable Atorvastatin prophylactic regime to prevent the development of POAF and other postoperative complications in these patients. Patients will be randomized to Atorvastatin 80mg or placebo 7 to 14 days preoperative until 30 days postoperative - a total of 37 to 44 days of treatment. The medication will be double blinded. The randomized studie will address the following hypotheses in patients undergoing open heart operation with solitary aortic valve replacement with a bioprosthetic valve that 1\) 7 to 14 days preoperative and until 30 days postoperative treatment with Atorvastatin 80 mg daily reduces the incidence of POAF in statin-naïve patients.

Detailed description

Trial Participants:

Enrolment for the study is planned to start February 2022 and continue until 266 patients have been enrolled.

DEFINITION OF POAF:

Postoperative AF (I48) is defined as irregular RR-intervals without a traceable p-wave before each QRS complex during at least 30 seconds or entire 12-lead ECG in symptomatic or asymptomatic patients with no prior history of atrial fibrillation or flutter are considered4. Continuous ECG monitoring (8-lead ward monitor) will recognise AF during the entire hospitalization. Anamnesis, electronic health record (EHR), or confirmatory rhythm strip or 12-lead ECG of AF until 30th postoperative day are also considered.

We will also report the burden of atrial fibrillation, and treatment with a rate controlling drug, antiarrhythmic drug, or electrical cardioversion.

Course of action:

Patients undergoing elective surgical aortic valve replacement with bioprosthesis at the Department of Cardiac Surgery at Odense University Hospital will be offered participation in the study.

Potentially eligible patients will be screened according to inclusion/exclusion criteria at the time after eligibility of surgery. This is assessed at a multidisciplinary team (MDT) conference (with attendance of cardiologist, cardiac surgeons and anaesthesiologist) based on clinical evaluation, echocardiographic ultrasound, coronary angiography and lung function test.

Patients eligible to participate in the study will be presented with the information of the study at the time of their out-patient appointment, according to normal routine at Odense University Hospital. At this appointment the patient receives a physical examination and journal record is obtained by a cardiac surgeon (approximately 7 to 14 days prior to planned surgery).

The study-information will be given by one of the participating doctors, while the patient has been informed of the possibility of bringing an assessor of their choice. The information will be delivered in a quiet room blocked to other appointments in the Department of Cardiothoracic Surgery.

During this meeting the patient will be informed of the purpose of this study and the written patient information will be submitted in detail. Patients will be given as much time as wanted after the oral information has been delivered to decide if they wish to participate in the study. Patients will be offered the possibility to call one of the doctors taking part in this study during this time, in case of additional questions. Subjects can leave the study at any time for any reason if they wish to do so, without any consequences.

Signed informed consent will be provided prior to any research procedures. A subject is registered when signed informed consent has been provided and assigned a subject identification code by the computer-generated code. A subject is randomized when a treatment and a randomisation number has been provided. A subject is considered enrolled in the study once the subject is randomized.

Patient data from EHR will be conducted according to study endpoints after signed informed consent is provided. Signed consent gives sponsor and sponsors representatives

Randomization:

Allocation to a numbered treatment pack (Atorvastatin or placebo - blinded) Randomization scheme will be set-up by OPEN data manager with control for beta-blockers and age, and then randomization per se will be executed with the use of REDCap.

The following will be recorded at the day of randomization:

* Conduct information for baseline characteristics * Transthoracic Echocardiography measurements

Collect baseline blood sample:

• Troponin, CK-MB, Creatinine, CRP

Commence study medication/treatment

Perioperative interventions and outcomes from the day of surgery to the day of discharge:

* Duration of aortic cross clamp (ACC), extracorporeal circulation (ECC), ventilatory support, intensive care unit stay period, hospital stay period * Continue study medication * Blood samples:

* Preoperative: Troponin, CK-MB, Creatinine, CRP, Plasma-Atorvastatin * Serial troponin and CK-MB levels: (6, 24, 48, and 96 hours after surgery). * Creatinine levels: 48 and 96 hours after surgery. * CRP levels: 48 and 96 hours after surgery * Monitor ECG by continuous Holter monitoring to commence as soon as possible after surgery and continue up to post-operative day 5 evening * Transthoracic Echocardiography on post-operative day 3-5 * Record fluid intake and output during the first 48 hours following surgery based on IV fluids administration, blood transfusion (if applicable), oral/nasogastric intake, and urine plus surgical drain output * Record intraoperative defibrillation, removal of external pacemaker, new PPM/ICD, vasopressors, blood transfusion, surgical re-exploration, renal replacement therapy, beta-blockers, ACEi/ARB, Amiodarone, Digoxin, Diuretics, Calcium channel blockers, Potassium supplements, NSAIDs or steroids, non-study statin, use of nephrotoxic antibiotics, contrast agents or potassium sparing diuretics (Yes/No)

Assessment at/after discharge from hospital:

* Continue study medications for 30 days after the surgery * Phone call on the 30th postoperative day to evaluate symptoms of discomfort compatible with atrial fibrillation * At the end of the study, all excess study medication can be returned at the local drugstore for safe disposal * Patient data from EHR will be conducted according to study endpoints.

Interventions

  • Drug Atorvastatin 80mg
    Dosage: 80 mg Form: Tablets Frequency: 1 tabl. per day. Duration: From 7 to 14 days prior to surgery until 30 days postoperative
  • Drug Placebo
    Form: Tablets Frequency: 1 tabl. per day. Duration: From 7 to 14 days prior to surgery until 30 days postoperative

Primary outcome measures

  • Number of Participants with POAF - In-hospital [Time frame: In-hospital up to 10 days]
  • Number of Participants with POAF - Early [Time frame: Early (≤30 days) incidence of POAF]
  • Total duration of POAF - In-hospital [Time frame: In-hospital up to 10 days]
Secondary outcome measures (12)
  • Rate of All-cause mortality - In-hospital [Time frame: In hospital up to 10 days]
  • Rate of All-cause mortality - Early [Time frame: Early (≤30 days)]
  • Rate of All-cause mortality - intermediate [Time frame: intermediate (1 year)]
  • Myocardial injury - Tn [Time frame: After surgery until discharge up to 10 days.]
  • Myocardial injury - CKMB [Time frame: After surgery until discharge up to 10 days.]
  • Stroke - Early [Time frame: Early (≤30 days)]
  • Stroke - Intermediate [Time frame: Intermediate (1 year)]
  • Trans ischemic attack - Early [Time frame: Early (≤30 days)]
  • Trans ischemic attack - Intermediate [Time frame: Intermediate (1 year)]
  • Myocardial infarction - Early [Time frame: Early (≤30 days)]
  • Myocardial infarction - Intermediate [Time frame: Intermediate (1 year)]
  • Permanent pacemaker - Early [Time frame: Early (≤30 days)]

Eligibility criteria

Inclusion criteria

  • Patients undergoing elective solitary SAVR with bioprosthesis
  • Patients who are in sinus rhythm and not taking any anti-arrhythmic medication, other than beta-adrenergic blocking agents, at the time of surgery
  • No prior use of HMG-CoA reductase inhibitors the last 3 months and at least 7 days prior to the time of surgery
  • Age >60 years
  • Willingness and provision of informed consent to be randomized

Exclusion criteria

  • Prior history of atrial fibrillation
  • Prior history of cardiac surgery
  • Known adverse reaction to HMG-CoA reductase inhibitors
  • Hepatic dysfunction (Alanin-aminotransferase more than twice the upper limit)
  • Creatinine >200 µmol/L
  • Known intolerance to statins or history of muscle toxicity with statins
  • Known intolerance to any of the excipients in Lipistad
  • Treatment with anti-viral medicine (glecaprevir/pibrentasvir) for hepatitis

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation
Randomized
Model
Parallel assignment
Masking
Quadruple blind
Primary purpose
Prevention

Study locations

Denmark · 1 center
  • Odense University Hospital — Odense

Publications

  • LaPar DJ, Crosby IK, Rich JB, Fonner E Jr, Kron IL, Ailawadi G, Speir AM; Investigators for Virginia Cardiac Surgery Quality Initiative. A contemporary cost analysis of postoperative morbidity after coronary artery bypass grafting with and without concomitant aortic valve replacement to improve patient quality and cost-effective care. Ann Thorac Surg. 2013 Nov;96(5):1621-7. doi: 10.1016/j.athoracs PMID 23972932
  • Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009 Jan;137(1):82-90. doi: 10.1016/j.jtcvs.2008.08.015. PMID 19154908
  • Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace. 2012 Feb;14(2):159-74. doi: 10.1093/europace/eur208. Epub 2011 Aug 6. PMID 21821851
  • Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed PMID 32860505
  • Arsenault KA, Yusuf AM, Crystal E, Healey JS, Morillo CA, Nair GM, Whitlock RP. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD003611. doi: 10.1002/14651858.CD003611.pub3. PMID 23440790
  • AlTurki A, Marafi M, Proietti R, Cardinale D, Blackwell R, Dorian P, Bessissow A, Vieira L, Greiss I, Essebag V, Healey JS, Huynh T. Major Adverse Cardiovascular Events Associated With Postoperative Atrial Fibrillation After Noncardiac Surgery: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol. 2020 Jan;13(1):e007437. doi: 10.1161/CIRCEP.119.007437. Epub 2020 Jan 16. PMID 31944855
  • Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019 Jul;16(7):417-436. doi: 10.1038/s41569-019-0166-5. PMID 30792496
  • Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017 Oct 1;52(4):665-672. doi: 10.1093/ejcts/ezx039. PMID 28369234

Identifiers

NCT: NCT05076019 · STARC210421_2

Primary sources (government registries)

View this study on ClinicalTrials.gov ↗