Midterm benefits of preoperative statin therapy in patients undergoing isolated valve surgery.
BACKGROUND
Recent data have suggested that statins are associated with reduced early mortality and cardiovascular events after valvular heart surgery. The midterm effects of preoperative statin therapy in the setting of valvular heart surgery are presently unclear.


METHODS
All patients (n=2,120) who underwent a valvular procedure between April 2004 and April 2010 were identified. Patients undergoing concomitant coronary artery bypass graft surgery were excluded. Two patient groups were studied: those who received preoperative statin therapy (n=663; 31.3%) and those who did not (n=1,457; 68.7%). Propensity score matching resulted in 381 matched pairs, thus addressing baseline risk imbalances. Thirty-day mortality, readmission rates, postoperative complications, and length of stay were analyzed. Late survival was ascertained by the Social Security Death Index.


RESULTS
In the matched group, 30-day mortality was 1.3% (5 of 381) for statin-treated patients versus 4.2% (16 of 381) for statin-untreated patients (p=0.03). After a mean follow-up of 33±23 months, statin therapy was associated with significantly reduced mortality (hazard ratio 0.63, 95% confidence interval: 0.43 to 0.93, p=0.019), independent of known cardiac risk factors. Weighted log rank tests revealed that the mortality difference between the two cohorts occurred early after surgery (p=0.015). Statin users were less likely to be readmitted to the intensive care unit (3.4% versus 8.1%, p=0.01). There were no other significant differences between the two groups in terms of postoperative complications and length of stay.


CONCLUSIONS
Preoperative statin administration is associated with early reductions in mortality among patients undergoing isolated valvular heart surgery, leading to improved late survival. Future prospective analyses are warranted to optimize statin therapy in this patient population.
Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611-2908, USA.
Muthiah
M
Vaduganathan
Neil J
NJ
Stone
Adin-Cristian
AC
Andrei
Richard
R
Lee
Preeti
P
Kansal
Robert A
RA
Silverberg
Robert O
RO
Bonow
Patrick M
PM
McCarthy
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care; D057216:Propensity Score; D018570:Risk Assessment; D015996:Survival Rate; D014481:United States; D055815:Young Adult
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors