Preoperative statin use and in-hospital outcomes following heart surgery in patients with unstable angina.
OBJECTIVE
Unstable angina (UA) is characterized by a state of coronary artery vascular inflammation and endothelial dysfunction. Statins mitigate inflammation and endothelial dysfunction and decrease mortality associated with percutaneous interventions for UA. We determined whether preoperative statin use is associated with decreased mortality and morbidity following coronary artery bypass+/-valve surgery for UA.


METHODS
Patients with CCS Class IV angina having CABG+/-valve surgery were identified (n=1706). A logistic regression model determined the association of preoperative statin use with in-hospital mortality (IHM). Propensity score analysis was used to match two sub-groups of patients (GrpI, on statins, n=534; GrpII, not on statins, n=534) on factors known to affect outcomes. Outcomes were IHM, intra-aortic balloon pump (IABP) use, perioperative myocardial infarction (PMI), prolonged (>24 h) ventilation (p-vent), stroke, and a composite outcome (comp) defined as any one or more of the above.


RESULTS
Of the 1706 patients, 1075 were on statins and 631 were not. Patients on statins were more likely to have isolated CABG, EF>40%, and be on a beta-blocker (P=0.0001); and less likely to have renal failure, MI<7 days, CHF, and undergoing urgent/emergent surgery (P=0.0001). Unadjusted rates of IHM (9 vs. 5%, P=0.001), stroke (4.4 vs. 2.3%, P=0.015), p-vent (28.4 vs. 19%, P=0.0001), and comp (32.5 vs. 22.8%, P=0.0001) were lower in patients receiving statins. After adjustment, statin use was not associated with a reduction in IHM (OR=1.0, 95% CI=0.6-1.5, P=0.85) or comp (OR=1.1, 95% CI=0.8-1.4, P=0.69). No significant differences were found in any of the propensity-adjusted outcomes for GrpI vs. GrpII: IHM (7.1 vs. 6.4%), PMI (2.8 vs. 1.7%), IABP use (3 vs. 3.8%), stroke (3.8 vs. 3.9%), p-vent (26.4 vs. 23.8%), comp (31.5 vs. 27.5%).


CONCLUSIONS
Preoperative statin use is not associated with a reduction in IHM or major morbidity following CABG+/-valve surgery in patients with UA.
Ali
Imtiaz S
IS
Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada. imtiaz.ali@dal.ca
Buth
Karen J
KJ
D000368:Aged; D000789:Angina, Unstable / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016017:Odds Ratio; D011292:Premedication; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors