Efficacy of Different Perioperative Statin Regimens on Protection Against Post-Coronary Artery Bypass Grafting Major Adverse Cardiac and Cerebral Events.
OBJECTIVE
Comparing different perioperative statin regimens for the prevention of post-coronary artery bypass grafting adverse events.


METHODS
A randomized, prospective study.


METHODS
Cardiothoracic surgical units in a government hospital.


METHODS
The study comprised 94 patients scheduled for elective, isolated on- or off- pump coronary artery bypass grafting.


METHODS
Patients were assigned randomly to 1 of the following 3 treatment groups: group I (80 mg of atorvastatin/day for 2 days preoperatively), group II (40 mg of atorvastatin/day for 5-9 days preoperatively), or group III (80 mg of atorvastatin/day for 5-9 days preoperatively). The same preoperative doses were restarted postoperatively and continued for 1 month.


RESULTS
Cardiac troponin I, creatine kinase, and C-reactive protein (CRP) levels were assayed preoperatively; at 8, 24, and 48 hours postoperatively; and at discharge. CRP levels at 24 hours (p = 0.045) and 48 hours (p = 0.009) were significantly lower in group III compared with the other 2 groups. However, troponin I levels at 8 hours (p = 0.011) and 48 hours (p = 0.025) after surgery were significantly lower in group II compared with group III. The incidence of postoperative major adverse cardiac and cerebrovascular events was assessed, and there was no significant difference among the 3 groups.


CONCLUSIONS
The 3 regimens did not result in any significant difference in outcomes, but only simple trends. The higher-dose regimen resulted in a significant reduction in the CRP level. Thus, more studies are needed to confirm the benefit of higher-dose statins for the protection from post-coronary artery bypass grafting adverse events.
Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt. Electronic address: aya.almarsafawi@pharma.cu.edu.eg.
Aya G
AG
Elmarsafawi
Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Maggie M
MM
Abbassi
Cardiovascular Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Sameh
S
Elkaffas
Cardiac Surgery Department, National Heart Institute, Giza, Egypt.
Hassan M
HM
Elsawy
Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Nirmeen A
NA
Sabry
D000368:Aged; D000069059:Atorvastatin / Q000008:administration & dosage* / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000534:rehabilitation; D003402:Creatine Kinase / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D019210:Troponin I / Q000097:blood
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019210:Troponin I; D002097:C-Reactive Protein; D000069059:Atorvastatin; D003402:Creatine Kinase
coronary artery bypass grafting; major adverse cardiac and cerebral events; statins