title: Effects of five preoperative cardiovascular drugs on mortality after coronary artery bypass surgery: A retrospective analysis of an observational study of 16, 192 patients.
abstract: BACKGROUND
  Statins reduce risk from coronary artery bypass graft (CABG) surgery, but the influence of angiotensin-converting enzyme inhibitors, alpha-2 adrenergic agonists, calcium channel blockers and beta-blockers is less clear.
  
  
  OBJECTIVE
  We investigated the association of each of these drugs with perioperative risk, accounting for different confounders, and evaluated the class, dose-response and long-term protective effect of statins.
  
  
  METHODS
  A retrospective analysis of observational data.
  
  
  METHODS
  United Kingdom.
  
  
  METHODS
  Sixteen thousand one hundred and ninety-two patients who underwent CABG surgery during the period 01 January 2004 to 31 December 2013 and contributed data to Primary Care Clinical Practice Research Datalink.
  Cardiovascular drugs.
  
  
  METHODS
  Perioperative mortality within 30 days of surgery.
  
  
  METHODS
  Five multivariable logistic regression models and a further Cox regression model were used to account for preexisting cardiovascular and other comorbidities along with lifestyle factors such as BMI, smoking and alcohol use.
  
  
  RESULTS
  Exposure to statins was most prevalent (85.1% of patients), followed by beta-blockers (72.8%), angiotensin-converting enzyme inhibitors (60.5%), calcium channel blockers (42.8%) and alpha-2 adrenergic agonists (1.2%). The mortality rate was 0.8% in patients not prescribed statins and 0.4% in those on statins. Statins were associated with a statistically significant reduced perioperative mortality in all five logistic regression models with adjusted odds ratios (OR) (95% confidence interval, 95% CI) ranging from 0.26 (0.13 to 0.54) to 0.35 (0.18 to 0.67). Cox regression for perioperative mortality [adjusted hazard ratio (95% CI) 0.40 (0.20 to 0.80)] and 6-month mortality [adjusted hazard ratio (95% CI) 0.63 (0.42 to 0.92)] produced similar results. Of the statin doses tested, only simvastatin 40 mg exerted protective effects. The other cardiovascular drugs lacked consistent effects across models.
  
  
  CONCLUSIONS
  Statins appear consistently protective against perioperative mortality from CABG surgery in multiple models, an effect not shared by the other cardiovascular drugs. Further data are needed on whether statins exert class and dose-response effects.
authors.affiliation: From the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham (SV, GNO, PM), Department of Cardiology, Wythenshawe Hospital, University Hospitals South Manchester NHS Trust, Manchester (AMM), Department of Anaesthesia, Royal Brompton Hospital, Sydney Street, London (TWHP), Integrative Physiology and Critical Illness, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK (CPWG), and Department of Anesthesiology & Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA (RDS).
authors.forename: Sudhir
authors.initials: S
authors.lastname: Venkatesan
authors.forename: George N
authors.initials: GN
authors.lastname: Okoli
authors.forename: Abdul M
authors.initials: AM
authors.lastname: Mozid
authors.forename: Thomas W H
authors.initials: TW
authors.lastname: Pickworth
authors.forename: Michael P W
authors.initials: MP
authors.lastname: Grocott
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sanders
authors.forename: Puja
authors.initials: P
authors.lastname: Myles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D008019:Life Style; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors