the effect of high-dose atorvastatin on postoperative troponin in patients undergoing non-cardiac surgery: a triple-blind randomized clinical trial

Background: cardiovascular complications account for a substantial proportion of perioperative complications. this study aimed to evaluate whether preoperative high-dose atorvastatin reduces postoperative changes in serum high-sensitivity cardiac troponin (hs-ctn) concentrations in patients at elevated cardiac risk undergoing noncardiac surgery.methods: in this triple-blind, parallel-group, randomized controlled trial, adults with a revised cardiac risk index (rcri) of 1 or greater scheduled for noncardiac surgery were randomized (1:1) to receive atorvastatin 80 mg 24 hours preoperatively or placebo. the primary outcome was the change in serum hs-ctn concentrations 24 hours after surgery. secondary outcomes included the incidence of major adverse cardiovascular events (mace) within 7 days after surgery, as well as cardiovascular death, myocardial infarction, stroke, heart failure, arrhythmia, or transient ischemic attack.results: a total of 112 patients with similar baseline characteristics were randomized and completed a 7-day follow-up. postoperative hs-ctn levels increased significantly in the placebo group (p<0.001) but decreased in the statin group (p<0.001), with a significant between-group difference favoring statin therapy (p<0.001). subgroup analyses by anesthesia type and prior statin use showed consistent findings. mace occurred in three patients (5.4%) in the statin group and two patients (3.6%) in the placebo group (p=1.00).conclusion: preoperative high-dose atorvastatin significantly reduced postoperative hs-ctn levels, indicating a biochemical cardioprotective effect, but it did not translate into a reduction of short-term clinical cardiovascular events. larger multicenter trials with longer follow-up are required to determine whether troponin reduction translates into improved clinical outcomes.