Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study.
OBJECTIVE
The aim of this study was to assess the effects of pre-operative statin therapy on cardiovascular events in the first 30-days after non-cardiac surgery.


RESULTS
We conducted an international, prospective, cohort study of patients who were ≥45 years having in-patient non-cardiac surgery. We estimated the probability of receiving statins pre-operatively using a multivariable logistic model and conducted a propensity score analysis to correct for confounding. A total of 15 478 patients were recruited at 12 centres in eight countries from August 2007 to January 2011. The matched population consisted of 2845 patients (18.4%) treated with a statin and 4492 (29.0%) controls. The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73-0.95; P = 0.007]. Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02). There were no statistically significant differences in the risk of myocardial infarction or stroke.


CONCLUSIONS
Among patients undergoing non-cardiac surgery, pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days. These results require confirmation in a large randomized trial.


BACKGROUND
Clinical Trials.gov NCT00512109.
Research Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil oberwanger@hcor.com.br.
Otavio
O
Berwanger
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Yannick
Y
Le Manach
Research Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Erica Aranha
EA
Suzumura
Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
Bruce
B
Biccard
Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
Sadeesh K
SK
Srinathan
Jagiellonian University Medical College, Krakow, Poland.
Wojciech
W
Szczeklik
Research Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Jose A Espirito
JA
Santo
Research Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Eliana
E
Santucci
Research Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Alexandre B
AB
Cavalcanti
Barts Heart Centre, Barts Health NHS Trust, London, UK.
R Andrew
RA
Archbold
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
P J
PJ
Devereaux
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cohort studies; Multivariate analysis; Perioperative period; Propensity score; Statin; Surgical procedures