title: Effect of perioperative statins on death, myocardial infarction, atrial fibrillation, and length of stay: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the influence of perioperative statin treatment on the risk of death, myocardial infarction, atrial fibrillation, and hospital and intensive care unit length of stay in statin-naive patients undergoing cardiac or noncardiac surgery.
  
  
  METHODS
  MEDLINE via PubMed, EMBASE, Biosis, and the Cochrane Central Register of Controlled Trials via Ovid. Additional studies were identified through hand searches of bibliographies, trial Web sites, and clinical experts. Randomized controlled trials reporting the effect of perioperative statins in statin-naive patients undergoing cardiac and noncardiac surgery were included.
  
  
  METHODS
  Two investigators independently selected eligible studies from original research published in any language studying the effects of statin use on perioperative outcomes of interest.
  
  
  METHODS
  Two investigators performed independent article abstraction and quality assessment.
  
  
  RESULTS
  Fifteen randomized controlled studies involving 2292 patients met the eligibility criteria. Random-effects meta-analyses of unadjusted and adjusted data were performed according to the method described by DerSimonian and Laird. Perioperative statin treatment decreased the risk of atrial fibrillation in patients undergoing cardiac surgery (relative risk [RR], 0.56; 95% CI, 0.45 to 0.69; number needed to treat [NNT], 6). In cardiac and noncardiac surgery, perioperative statin treatment reduced the risk of myocardial infarction (RR, 0.53; 95% CI, 0.38 to 0.74; NNT, 23) but not the risk of death (RR, 0.62; 95% CI, 0.34 to 1.14). Statin treatment reduced mean length of hospital stay (standardized mean difference, -0.32; 95% CI, -0.53 to -0.11) but had no effect on length of intensive care unit stay (standardized mean difference, -0.08; 95% CI, -0.25 to 0.10).
  
  
  CONCLUSIONS
  Perioperative statin treatment in statin-naive patients reduces atrial fibrillation, myocardial infarction, and duration of hospital stay. Wider use of statins to improve cardiac outcomes in patients undergoing high-risk procedures seems warranted.
authors.affiliation: Division of General Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA. vineetc@umich.edu
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
authors.forename: David H
authors.initials: DH
authors.lastname: Wesorick
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Sussman
authors.forename: Todd
authors.initials: T
authors.lastname: Greene
authors.forename: Mary
authors.initials: M
authors.lastname: Rogers
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007902:Length of Stay; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors