title: Effect of preoperative statins in patients without coronary artery disease who undergo cardiac surgery.
abstract: OBJECTIVE
  3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been shown to have pleiotropic effects in addition to their lipid-lowering properties. Some studies have shown the beneficial effect of preoperative statins on operative outcomes in coronary artery bypass grafting. However, the effect of preoperative statins in patients without coronary artery disease who undergo cardiac surgery remains poorly defined.
  
  
  METHODS
  We performed a retrospective review of 1389 consecutive patients undergoing cardiac valve surgery between January of 2002 and December of 2005. Patients undergoing concomitant coronary artery bypass surgery and those with a history of myocardial infarction and coronary interventions were excluded. Of this cohort, 363 patients were receiving a statin preoperatively and 1026 patients were not. Propensity scores were constructed with patients' demographics, clinical data, and the year of procedure. Generalized estimating equations, including the propensity score as a covariate, were used to investigate whether preoperative statin use is associated with improved operative outcomes.
  
  
  RESULTS
  The crude operative mortality rate was 0.8% and 2.3%, the incidence of stroke was 1.7% and 2.9%, and the incidence of perioperative myocardial infarction was 2.2% and 2.4% in the statin and non-statin groups, respectively. Generalized estimating equations showed that preoperative statin use is associated with lower mortality (odds ratio: 0.25, 95% confidential interval: 0.12-0.54). Preoperative statin use was not significantly associated with an incidence of stroke (odds ratio: 0.48, 95% confidential interval: 0.19-1.22) or perioperative myocardial infarction (odds ratio: 0.91, 95% confidential interval: 0.43-1.91) in this cohort.
  
  
  CONCLUSIONS
  Preoperative use of statins may improve operative outcomes in patients without coronary artery disease who undergo cardiac surgery.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA. mtabata@post.harvard.edu
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Zain
authors.initials: Z
authors.lastname: Khalpey
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.forename: Fredrick Y
authors.initials: FY
authors.lastname: Chen
authors.forename: R Morton
authors.initials: RM
authors.lastname: Bolman
authors.forename: James D
authors.initials: JD
authors.lastname: Rawn
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D003324:Coronary Artery Disease; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors