title: Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study.
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29403, USA.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Clark
authors.forename: John S
authors.initials: JS
authors.lastname: Ikonomidis
authors.forename: Fred A
authors.initials: FA
authors.lastname: Crawford
authors.forename: Arthur
authors.initials: A
authors.lastname: Crumbley
authors.forename: John M
authors.initials: JM
authors.lastname: Kratz
authors.forename: Martha R
authors.initials: MR
authors.lastname: Stroud
authors.forename: Robert F
authors.initials: RF
authors.lastname: Woolson
authors.forename: James J
authors.initials: JJ
authors.lastname: Bruce
authors.forename: Joyce S
authors.initials: JS
authors.lastname: Nicholas
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Francis G
authors.initials: FG
authors.lastname: Spinale
mesh_terms: 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
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors