Response to perioperative statin therapy in cardiac surgery: a matter of race and timing?

We read with great interest the recent article by Zheng et al. describing the STICS clinical trial testing whether perioperative rosuvastatin administration lowers rates of postoperative atrial fibrillation (AF) and myocardial infarction after coronary artery bypass grafting (CABG) or CABG plus aortic valve surgery (1). These are important questions because we know that postoperative AF after cardiac surgery has significant implications on health care outcomes and costs (2). Notably, the STICS study revealed no difference in postoperative AF rates between placebo and rosuvastatin treated groups. This data supports very different conclusions than previous studies, which have tested a similar question and found a significant reduction in postoperative AF with perioperative statin therapy in both cardiac and non-cardiac surgery (3,4). We surmise that there are methodological, demographical, and pharmacological aspects of this new study that may help explain the unexpected results