Preoperative statin therapy is associated with lower requirement of renal replacement therapy in patients undergoing cardiac surgery: A meta-analysis of observational studies (original) (raw)
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The Journal of Thoracic and Cardiovascular Surgery, 2006
Objective: Statin therapy in ambulatory populations is associated with a significant reduction in adverse cardiovascular events, including death and myocardial infarction. Much less is known about the beneficial effects of statins on acute perioperative cardiovascular events. The purpose of this study was to determine whether preoperative statin therapy is associated with a reduced risk of early cardiac death or nonfatal, in-hospital postoperative myocardial infarction after primary, elective coronary artery bypass graft surgery requiring cardiopulmonary bypass.
Circulation, 2004
Background— Statin therapy in nonsurgical patient populations is associated with a significant reduction in adverse cardiovascular events, including death, myocardial infarction (MI), and stroke. Recently, statin therapy was shown to be associated with a reduced incidence of postoperative mortality in patients undergoing major noncardiac vascular surgery. We investigated the influence of preoperative statin therapy on adverse outcomes after primary coronary artery bypass graft (CABG) surgery. Methods and Results— A retrospective cohort study of patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (n=1663) between January 1, 2000 and December 31, 2001 at the Texas Heart Institute was performed. Patients were classified into 2 groups: patients receiving preoperative statin therapy (n=943) and patients not receiving preoperative antihyperlipidemic therapy (n=720). To determine if preoperative statin therapy was independently associated with a reduction in the risk...
Preoperative statin use and outcomes following cardiac surgery
International journal of cardiology, 2005
Background: Cardiac surgery carries a 2-3% early mortality due in part to perioperative myocardial infarction (PMI), low-output syndrome (LOS), and arrhythmias. Statins attenuate thrombogenesis, normalize endothelial dysfunction, and mitigate the oxidative stress and reperfusion injury characteristic of such complications. We sought to determine whether preoperative statin use is associated with reduced early mortality and major morbidity following cardiac surgery. Methods: Patients having isolated coronary artery bypass grafting (CABG), valve, or combined CABG/valve surgery between May 1998 and June 2003 (n=5469) were identified. A logistic regression model was generated to determine the association of preoperative statin use with in-hospital mortality (IHM). Propensity score analysis was used to match two subgroups of patients (Group I, on statins, n=1443; Group II, not on statins, n=1443) on multiple factors known to impact cardiac surgical outcome. Outcomes assessed were IHM, intra-aortic balloon pump (IABP) use, PMI, prolonged (N24 h) ventilation (p-vent), stroke, and a composite end point (comp) defined as any one or more of the above. Results: Of the 5469 patients, 3555 were on statins and 1914 were not. Unadjusted rates of IHM (2.6% vs. 5.0%), stroke (1.9% vs. 3.3%), pvent (10.2% vs. 16.6%), and comp (12.7% vs. 19.5%) were lower ( p=0.0001) in patients receiving statins. After adjustment, statin use was not associated with a reduction in IHM (OR=0.9, 95% CI=0.6-1.2, p=0.36) or comp (OR=0.9, 95% CI=0.8-1.1, p=0.31). After matching two subgroups using propensity score for statin, no significant differences were found in any of the adjusted outcomes for Group I vs. Group II: IHM (4.0% vs. 4.6%), PMI (1.5% vs. 1.1%), p-vent (15.8% vs. 15.7%), IABP use (2.0% vs. 2.3%), stroke (3.0% vs. 3.3%), and comp (19.1% vs. 18.8%). Conclusions: Preoperative statin use is not associated with a reduction in IHM or major morbidity following cardiac surgery.
Preoperative statin therapy in cardiac surgery: a meta-analysis of 90 000 patients
European Journal of Cardio-Thoracic Surgery, 2014
The objective of this systematic literature review with meta-analysis was to determine the strength of evidence for a preoperative statin on the reduction of adverse postoperative outcomes in patients undergoing cardiac surgery. Randomized controlled (RCT) and observational trials were searched in online databases that reported about the effects of preoperative statin therapy on major adverse clinical outcomes after cardiac surgery. Analysed outcomes included early all-cause mortality, myocardial infarction, atrial fibrillation (AF), stroke and renal failure using a priori-defined criteria. Effect estimates were calculated and are given as odds ratio (OR) with 95% confidence intervals (95% CI) using fixedor random-effect models. Literature search of all major databases retrieved 2371 studies. After screening, a total of 54 trials were identified (12 RCT, 42 observational) that reported outcomes of 91 491 cardiac surgery patients with (n = 46 614; 51%) or without (n = 44 877; 49%) preoperative statin therapy. Preoperative statin use resulted in a 0.9% absolute risk (2.6 vs 3.5%) and a 31% odds reduction for early all-cause mortality (OR 0.69; 95% CI 0.59-0.81; P < 0.0001). In addition, statin treatment before surgery was associated with a substantial reduction (P < 0.01) in the postoperative end-points AF (OR 0.71; 95% CI 0.61-0.82), new-onset AF (OR 0.68; 95% CI 0.54-0.85), stroke (OR 0.83; 95% CI 0.74-0.93), stay on intensive care unit (weighted mean difference [WMD] −0.14; 95% CI −0.23 to −0.03; P < 0.01) and in-hospital stay (WMD −0.57; 95% CI −0.76 to −0.38; P < 0.01). No statistical differences were found between groups with regard to myocardial infarction or renal failure. In conclusion, the current systematic review strengthens the evidence that preoperative statin therapy extends substantial clinical benefit to early postoperative outcomes in cardiac surgery patients.
Clinical Cardiology, 2013
Background: Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) reduce perioperative cardiac events in high-risk patients undergoing cardiovascular surgery. However, there is paucity of data on the role of statins in patients undergoing intermediate-risk noncardiac, nonvascular surgery (NCNVS). Hypothesis: Statins are cardioprotective in intermediate-risk NCNVS. Methods: We identified a retrospective cohort of patients undergoing intermediate risk NCNVS. Our composite end point included 30-day all-cause mortality, atrial fibrillation (AF), and nonfatal myocardial infarction (MI). A stepwise logistic regression with adjustment using propensity scores was performed to determine if statin therapy was independently associated with the risk reduction of adverse postoperative cardiovascular outcomes. Results: We identified 752 patients. Seventy-five of them (9.97%) developed composite end points; 10 (1.33%) had in-hospital nonfatal MI, 44 (5.85%) developed AF, and 35 (4.65%) died within 30 days. The 30-day all-cause mortality was 31/478 (6.48%) among statin nonusers vs 4/274 (1.45%) for statin users (P < 0.002). As compared with nonusers, patients on statin therapy had a 5-fold reduced risk of 30-day all-cause mortality. Statin therapy was associated with decreased CEP after adjusting for baseline characteristics, with a propensity score to predict use of statins (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.30-0.97, P = 0.039). After further adjustment for propensity score, diabetes mellitus, percutaneous coronary intervention, and prior coronary artery bypass grafting, statin therapy proved beneficial (OR: 0.51, 95% CI: 0.28-0.92, P = 0.026). Conclusions: Statin use in the perioperative period was associated with a reduction in cardiovascular adverse events and 30-day all-cause mortality in patients undergoing intermediate-risk NCNVS.
2005
We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery. BACKGROUND Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter. METHODS A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect. RESULTS Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p ϭ 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p ϭ 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins. CONCLUSIONS Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.
Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials
Critical Care, 2016
BACKGROUND: Several studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials (RCTs) show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients. METHODS: Electronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery. Postoperative outcomes were acute kidney injury, atrial fibrillation, myocardial infarction, stroke, infections, and mortality. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using fixed-effects meta-analyses. Primary analysis was restricted to trials with low risk of bias according to Cochrane methodology, and sensitivity analyses examined whether the risk of bias of included studies was associated with different results. We performed trial sequential analysis (TSA) to test the strength of the results. RESULTS: We included data from 23 RCTs involving 5102 patients. Meta-analysis of trials with low risk of bias showed that statin therapy was associated with an increase in acute kidney injury (314 of 1318 (23.82%) with statins versus 262 of 1319 (19.86%) with placebo; OR 1.26 (95%CI 1.05 to 1.52); p = 0.01); these results were supported by TSA. No difference in postoperative atrial fibrillation, myocardial infarction, stroke, infections, or mortality was present. On sensitivity analysis, statin therapy was associated with a slight increase in hospital mortality. Meta-analysis including also trials with high or unclear risk of bias showed no beneficial effects of statin therapy on any postoperative outcomes. CONCLUSIONS: There is no evidence that statin therapy in the days prior to cardiac surgery is beneficial for patients' outcomes. Particularly, statins are not protective against postoperative atrial fibrillation, myocardial infarction, stroke, or infections. Statins are associated with a possible increased risk of acute kidney injury and a detrimental effect on hospital survival could not be excluded. Future RCTs should further evaluate the safety profile of this therapy in relation to patients' outcomes and assess the more appropriate time point for discontinuation of statins before cardiac surgery. (2016). Perioperative statin therapy in cardiac surgery: a metaanalysis of randomized controlled trials. Critical Care, 20(1):395.
F1000 - Post-publication peer review of the biomedical literature, 2019
The aim of this study was to assess the effects of pre-operative statin therapy on cardiovascular events in the first 30-days after non-cardiac surgery. Methods and results We conducted an international, prospective, cohort study of patients who were ≥45 years having in-patient non-cardiac surgery. We estimated the probability of receiving statins pre-operatively using a multivariable logistic model and conducted a propensity score analysis to correct for confounding. A total of 15 478 patients were recruited at 12 centres in eight countries from August 2007 to January 2011. The matched population consisted of 2845 patients (18.4%) treated with a statin and 4492 (29.0%) controls. The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73-0.95; P ¼ 0.007]. Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P ¼ 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P ¼ 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P ¼ 0.02). There were no statistically significant differences in the risk of myocardial infarction or stroke. Conclusion Among patients undergoing non-cardiac surgery, pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days. These results require confirmation in a large randomized trial.
Scientific Reports, 2017
A controversy effect of perioperative statin use for preventing postoperative atrial fibrillation (POAF) and acute kidney injury (AKI) after cardiac surgery still remains. We thus performed current systematic review and meta-analysis to comprehensively evaluate effects of statin in cardiac surgery. 22 RCTs involving 5243 patients were included. Meta-analysis of 18 randomized controlled trials with 3995 participants suggested that perioperative statin use could decrease the risk of POAF (relative risk [RR] 0.69, 95%CI 0.56 to 0.86, P = 0.001), with a moderate heterogeneity (I 2 = 65.7%, P H < 0.001). And the beneficial effect was found only in patients receiving coronary artery bypass graft (CABG), but not in patients undergoing valve surgery. However, perioperative statin use was not associated with lower risks of AKI (RR 0.98, 95%CI 0.70 to 1.35, P = 0.884, I 2 = 33.9%, P H = 0.157) or myocardial infarction (MI) (RR 0.84, 95%CI 0.58 to 1.23, P = 0.380, I 2 = 0%, P H = 0.765), and even an increased trend of AKI was observed in patients with valve surgery. Perioperative statin use could decrease the inflammation response with no impact on clinical outcomes. In conclusion, perioperative statin use is useful in preventing POAF, particularly in patients with CABG, and ameliorate inflammation, while it has no effect on AKI and MI after cardiac surgery. Despite advanced protection of cardiopulmonary bypass (CPB) and other techniques supported during cardiac surgery, the major post-operation complications are still like Pandora's Box, contributing to the substantial mortality and morbidity and increasing medical costs 1, 2. Currently, researches demonstrated that these complications were mainly driven by post-perfusion syndrome, oxidative stress and release of inflammation cytokines after cardiac surgery 3, 4. Though as transient complications, the indisputable fact is that postoperative atrial fibrillation (POAF) and acute kidney injury (AKI), the most frequent complications after cardiac surgery, are independent risk factors related to poor prognosis in patients received cardiac surgery 5, 6. Observational studies, randomized controlled trials (RCTs), and meta-analysis have demonstrated that perioperative statin use could decrease the incidence of POAF and AKI 7-10 , and latest guidelines suggested statins should be administrated in all patients undergoing coronary artery bypass graft (CABG) except for specific contradictions 11. However, recent studies fail to verify the beneficial effect of statin use in cardiac surgery, and the controversy still exists 12-16. Though many meta-analyses have been performed, this issue is still fuzziness. Therefore, we further systematically summarized current evidence of RCTs and meta-analyses to provide a