Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study.
BACKGROUND
Cardiac surgical procedures can be associated with significant morbidity and mortality. Recently, it has been recognized that statins might induce multiple biologic effects independent of lipid lowering that could potentially ameliorate adverse surgical outcomes. Accordingly, this study tested the central hypothesis that pretreatment with statins before cardiac surgery would reduce adverse postoperative surgical outcomes.


METHODS
Demographic and outcomes data were collected retrospectively for 3829 patients admitted for planned cardiac surgery between February 1994 and December 2002. Statin pretreatment occurred in 1044 patients who were comparable with non-statin-pretreated (n = 2785) patients with regard to sex, race, and age. Primary outcomes examined included postoperative mortality (30-day) and a composite morbidity variable.


RESULTS
The odds of experiencing 30-day mortality and morbidity were significantly less in the statin-pretreated group, with unadjusted odds ratios of 0.43 (95% confidence interval [CI], 0.28-0.66) and 0.72 (95% CI, 0.61-0.86), respectively. Risk-adjusted odds ratios for mortality and morbidity were 0.55 (95% CI, 0.32-0.93) and 0.76 (95% CI, 0.62-0.94), respectively, by using a logistic regression model and 0.51 (95% CI, 0.27-0.94) and 0.71 (95% CI, 0.55-0.92), respectively, in the propensity-matched model, demonstrating significant reductions in 30-day morbidity and mortality. In a subsample of patients undergoing valve-only surgery (n = 716), fewer valve-only patients treated with statins experienced mortality, although these results were not statistically significant (1.96% vs 7.5%).


CONCLUSIONS
These findings indicate that statin pretreatment before cardiac surgery confers a protective effect with respect to postoperative outcomes.
Clark
Leslie L
LL
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29403, USA.
Ikonomidis
John S
JS
Crawford
Fred A
FA
Crumbley
Arthur
A
Kratz
John M
JM
Stroud
Martha R
MR
Woolson
Robert F
RF
Bruce
James J
JJ
Nicholas
Joyce S
JS
Lackland
Daniel T
DT
Zile
Michael R
MR
Spinale
Francis G
FG
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors