title: Continuative statin therapy after percutaneous coronary intervention improves outcome in coronary bypass surgery: a propensity score analysis of 2501 patients.
abstract: OBJECTIVE
  A history of percutaneous coronary intervention increases the risk of death and complications of coronary artery bypass grafting. This retrospective multicenter study evaluated the impact of continuative use of statin on postoperative outcomes when subsequent elective coronary artery bypass grafting is required after percutaneous coronary intervention.
  
  
  METHODS
  Among 14,575 patients who underwent isolated first-time coronary artery bypass grafting between January 2000 and December 2010, 2501 who had previous percutaneous coronary intervention with stenting and fulfilled inclusion criteria were enrolled. Continuative statin therapy was used in 1528 patients and not used in 973 patients. Logistic multiple regression and propensity score analyses were used to assess the risk-adjusted impact of statin therapy on in-hospital mortality and major adverse cardiac events. The Cox proportional hazards model was constructed to assess the effect of continuative statin therapy on 24-month outcome.
  
  
  RESULTS
  At multivariate analysis, age more than 70 years, 3-vessel or 2-vessel plus left main coronary disease, multivessel percutaneous coronary intervention, ejection fraction 0.40 or less, diabetes mellitus, and logistic European System for Cardiac Operative Risk Evaluation 5 or greater were independent predictors of hospital mortality and major adverse cardiac events. After propensity score matching, conditional logistic regression analysis demonstrated that continuative statin therapy before coronary artery bypass grafting reduced the risk for hospital and 2-year mortality (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.12-0. 57; P=.004 and OR, 0.6; 95% CI, 0.36-0.96; P=.04, respectively) and major adverse cardiac events (OR, 0.31; 95% CI, 0.18-0.78; P=.003 and OR, 0.5; 95% CI, 0.34-0.76; P=.006, respectively).
  
  
  CONCLUSIONS
  Long-term statin treatment after percutaneous coronary intervention improves early and midterm outcome when surgical revascularization will be required.
authors.affiliation: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy. Electronic address: vitomannacio2@libero.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Mannacio
authors.affiliation: Divisions of Cardiology and Cardiac Surgery, Yale Medical School, New Haven, Conn; Cardiology, University College London Hospital, London, United Kingdom.
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Santobono-Pausillipon, Naples, Italy.
authors.forename: Anita
authors.initials: A
authors.lastname: Antignano
authors.affiliation: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Mottola
authors.affiliation: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Tommaso
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Vosa
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007558:Italy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors