Preoperative statin therapy and troponin T predict early complications of coronary artery surgery.
BACKGROUND
Pretreatment with statins reduces early ischemic events after percutaneous coronary interventions, primarily in patients with a high level of inflammation markers. We sought to examine the association between preoperative statin therapy, systemic inflammation, and myocardial ischemia with the occurrence of early cardiac complications after coronary artery bypass grafting surgery.


METHODS
One hundred forty-one consecutive patients who underwent coronary artery bypass grafting surgery from two university tertiary hospitals were stratified according to their preoperative status of statin therapy (87 treated and 54 nontreated). Preoperative blood samples were collected for measurement of lipid parameters, C-reactive protein, interleukin-6, and troponin T. The evaluated primary endpoint was a composite of death and myocardial infarction at 30 days.


RESULTS
Patients undergoing preoperative statin therapy showed a reduced incidence of death (2.3% versus 13.0%, p = 0.012), myocardial infarction (5.7% versus 18.5%, p = 0.017), and primary combined endpoint (8.0% versus 22.2%, p = 0.017). In the multivariate model, preoperative troponin T greater than 0.01 ng/mL (odds ratio 6.85, p = 0.001) and nonstatin therapy (odds ratio 4.2, p = 0.01) predicted a higher risk of primary endpoint. Statins showed a significant interaction with troponin T status and benefited primarily those patients with positive troponin T. Among 19 patients with troponin T greater than 0.01 ng/mL, the primary endpoint occurred in all 6 nonstatin-treated patients, but it occurred in only 1 of 13 statin-treated patients (p < 0.001). Neither C-reactive protein nor interleukin-6 predicted early complications, nor did they interact with statin therapy (p = not significant).


CONCLUSIONS
Preoperative statin therapy reduces early complications and offers additional protection in patients with positive troponin T status, regardless of inflammatory markers.
Pascual
Domingo A
DA
Department of Cardiology, Hospital Universitario Arrixaca, Murcia, Spain. dapascual@servicam.com
Arribas
Jose M
JM
Tornel
Pedro L
PL
Marín
Francisco
F
Oliver
Clara
C
Ahumada
Miguel
M
Gomez-Plana
Jesus
J
Martínez
Pedro
P
Arcas
Ramón
R
Valdes
Mariano
M
D000368:Aged; D000069059:Atorvastatin; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D015994:Incidence; D015850:Interleukin-6 / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D017035:Pravastatin / Q000627:therapeutic use; D011292:Premedication; D011300:Preoperative Care; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use; D018570:Risk Assessment; D019821:Simvastatin / Q000627:therapeutic use; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000517:prevention & control; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D015850:Interleukin-6; D008055:Lipids; D011758:Pyrroles; D020107:Troponin T; D002097:C-Reactive Protein; D000069059:Atorvastatin; D019821:Simvastatin; D052279:Creatine Kinase, MB Form; D017035:Pravastatin