Preoperative statin therapy in cardiac surgery: a meta-analysis of 90 000 patients (original) (raw)
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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.
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 use and outcomes after cardiac surgery
2009
Background. It has been suggested that the routine use of statins preoperatively would reduce the risk of postoperative infection. We conducted this study to explore whether preoperative statin use was associated with infection after cardiac surgery (recipients of which have a higher-than-average risk of postoperative infection). Methods. We performed secondary analysis of data collected in a prospective cohort study of adults who underwent nontransplant cardiac surgery in a university hospital during the period January 1999 through December 2005. Outcomes were ascertained in a blinded and independent fashion. Results. Of the 7733 patients, 2657 (34%) were taking statins preoperatively; the proportion increased from 16% during 1999-2000 to 53% during 2003-2005 (, by test for trend). There was no association between P ! .001 preoperative statin use and postoperative infection: 214 statin users (8.1%) versus 425 statin nonusers (8.4%) developed an infection within 30 days after surgery. Factors associated with increased risk of infection after cardiac surgery included diabetes mellitus, heart failure, chronic obstructive pulmonary disease, increasing age, elevated baseline creatinine level, and longer duration of cardiopulmonary bypass but not statin use (adjusted odds ratio, 1.08; 95% confidence interval, 0.89-1.31). Conclusions. Preoperative statin use was not associated with a reduction in the rate of postoperative infection among patients who underwent cardiac surgery. This lack of apparent benefit for high-risk patients argues against the routine use of statins as a preoperative strategy for lower-risk patients and supports calls for randomized trials to define whether preoperative statin use influences postoperative rates of infection.
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
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.
British journal of anaesthesia, 2015
Statins feature documented benefits for primary and secondary prevention of cardiovascular disease and are thought to improve perioperative outcomes in patients undergoing surgery. To assess the clinical outcomes of perioperative statin treatment in statin-naive patients undergoing surgery, a systematic review was performed. Studies were included if they met the following criteria: randomized controlled trials, patients aged ≥18 yr undergoing surgery, patients not already on long-term statin treatment, reported outcomes including at least one of the following: mortality, myocardial infarction, atrial fibrillation, stroke, and length of hospital stay. The following randomized clinical trials were excluded: retrospective studies, trials without surgical procedure, trials without an outcome of interest, studies with patients on statin therapy before operation, or papers not written in English. The literature search revealed 16 randomized controlled studies involving 2275 patients. Pool...
Journal of the American College of Cardiology, 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.
Postoperative Cardiac Surgery Outcomes in a Statin-Native Population
Anesthesia, essays and researches
Statin utilization had been associated with improved survival after cardiac surgery. We aim to study whether perioperative treatment with statin could be associated with increased postoperative complications. This was a retrospective, descriptive, single-center study. We analyzed morbidity after cardiac surgery as well as the outcome related to statin therapy in a tertiary cardiac center. A total of 202 consecutive patients were enrolled over 1 year after cardiac surgery. Patients were divided into two groups; Group I - statin users and Group II - nonusers. Measurements were baseline and follow-up laboratory markers for muscular injury including cardiac muscle and hepatic injuries and renal injuries. The incidence of rhabdomyolysis and elevation of liver enzymes did not differ between both groups. Postoperative atrial fibrillation was significantly lower in the statin group ( = 0.02). In addition, peak cardiac troponin and creatine kinase-MB did not differ significantly in the stati...