Pre-operative Statin Therapy Improves Clinical Outcomes among Cardiac Surgical Patients: Results from a Meta-Analysis

May 29, 2008 By Vijayalakshmi Kunadian MBBS MD MRCP [mailto:vkunadian@perfuse.org]

European Heart Journal-Germany: A recent meta-analysis demonstrates significant clinical benefits with pre-operative statin therapy among 31, 725 cardiac surgical patients.

Among patients with coronary artery disease and those who have undergone coronary artery bypass surgery, statin therapy has been demonstrated to prevent progression of atherosclerosis, reduce the need for repeat revascularization procedures and mortality following coronary artery bypass surgery.

In a recent study published in the European Heart Journal [see link below], investigators from Germany performed a meta-analysis to determine the impact of pre-operative statin therapy prior to cardiac surgery in reducing the incidence of early (death within 30 days after surgery), all-cause mortality and major adverse post-operative events. They performed a systematic review of randomized and observational trials conducted from 1966 to February 2008 that consisted of information regarding pre-operative statin therapy and post-operative outcome data.

After analyzing 1197 studies, the researchers included 19 studies performed between 1999 and 2007 (3 randomized and 16 observational studies) consisting of 31, 725 patients. Of these 17,201 (54.2%) were on pre-operative statin therapy and 14, 524 (45.8%) were without statin therapy consisting of patients undergoing bypass graft surgery and valve surgeries.

This study demonstrated that pre-operative statin therapy resulted in significant reduction in mortality (n=28,517: 2.2% vs. 3.7%, p<0.0001), atrial fibrillation (n=7643: 24.9% vs. 29.2%, OR 0.67; 95% CI 0.51 to 0.88 p<0.0001) and stroke (n=16,390: 2.1% vs. 2.9%, OR 0.74; 95% CI 0.60 to 0.91, p=0.001) compared with control group without statin therapy. However, there was no impact of pre-operative statin therapy on the occurrence of myocardial infarction (n=14330: 4.2% vs. 3.9%, OR 1.11; 95% CI 0.93 to 1.33, p=0.373) and renal failure (n=6408: 3.9% vs. 4.5%, OR 0.78; 95% CI 0.46 to 1.31, p=0.275) compared with the control group.

Although this study has limitations that are attributed to a meta-analysis including selection bias and other treatment effects, it provides insight into the beneficial effects of pre-operative statin therapy among cardiac surgical patients. While these finding would require further confirmation in prospective randomized clinical trials, the authors recommend intensive pre-operative lipid lowering strategy among cardiac surgical patients with known coronary artery disease and multiple cardiac risk factors.

Source
http://eurheartj.oxfordjournals.org/cgi/content/full/ehn198v1