Objective: This study was designed to investigate whether patients with stable coronary artery disease (CAD) receiving chronic statin treatment who are undergoing noncardiac emergency surgery benefit from acute atorvastatin reload. Methods: A total of 500 patients with stable CAD and regular administration of statin before noncardiac emergency surgery were randomized to atorvastatin reload (n = 250) or placebo (n = 250). All patients received atorvastatin treatment thereafter. The primary end point was a 30-day incidence of major adverse cardiac events (MACE). Secondary end points were the incidence of atrial fibrillation (AF) during hospitalization and length of hospital stay. Results: The primary end point occurred in 2.4% of patients treated with atorvastatin reload and in 8% in the placebo arm (p = 0.0088). The incidence of AF during hospitalization was 6.8% in patients treated with atorvastatin reload and 17% in the placebo arm (p = 0.0003). Compared with the placebo arm, the atorvastatin reload arm shortened the length of stay (9.8 +/- 3.3 vs. 10.6 +/- 3.5 days, p = 0.009). Multivariable analysis suggested that atorvastatin reload conferred a 65% risk reduction of 30day MACE (odds ratio 0.35, 95% confidence interval 0.18-0.86; p = 0.005). Conclusion: The trial suggests that atorvastatin reload may improve the clinical outcome of patients with stable CAD receiving chronic statin treatment who are undergoing noncardiac emergency surgery. (c) 2014 S. Karger AG, Basel