Effect of Dose and Timing of Preoperative Statins on Mortality After Coronary Artery Bypass Surgery.
BACKGROUND
Preoperative statin administration is associated with reduced mortality risk after a coronary artery bypass graft operation. However, the optimal dose and timing are unknown.


METHODS
We retrospectively reviewed data from 3,025 primary isolated coronary artery bypass graft surgery patients at our institution. Patients were divided into three groups, according to timing of their preoperative statin: 24 hours or less (n = 1,788), 24 to 72 hours (n = 452), or more than 72 hours before operation or no dose (n = 781). We then grouped patients by preoperative dose: no statin (n = 739), 20 mg or less (n = 920), or more than 20 mg (n = 1,284) atorvastatin or equivalent. Primary outcome was 30-day all-cause postoperative mortality.


RESULTS
Thirty-day all-cause mortality was significantly lower for patients taking a statin 24 hours or less preoperatively (1.7%) compared with 24 to 72 hours (2.9%), more than 72 hours, or no dose (3.8%). Multivariate analysis of a propensity-matched cohort showed taking statins 24 hours or less preoperatively was associated with reduced 30-day all-cause mortality (odds ratio 0.52, 95% confidence interval: 0.28 to 0.98, p = 0.04) versus more than 24 hours or no dose. For preoperative statin dose, 30-day all-cause mortality was significantly lower when taking 20 mg or less(1.8%) or more than 20 mg atorvastatin or equivalent (2.1%) than when taking none (3.8%). In multivariate analysis of the propensity-matched cohort, more than 20 mg preoperative dose was associated with a 68% reduction of 30-day all-cause mortality (odds ratio 0.32, 95% confidence interval: 0.13 to 0.82, p = 0.02) compared with no preoperative statin. However, a 20 mg or less preoperative dose showed no mortality reduction.


CONCLUSIONS
Both statin use 24 hours or less preoperatively and preoperative statin dose of more than 20 mg were independently associated with decreased 30-day all-cause mortality after coronary artery bypass graft surgery.
Baylor College of Medicine, Houston, Texas.
Michael
M
Curtis
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas.
Yi
Y
Deng
Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston, Texas.
Vei-Vei
VV
Lee
Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston, Texas.
MacArthur A
MA
Elayda
Department of Cardiovascular Surgery, Baylor College of Medicine and Texas Heart Institute, Houston, Texas.
Joseph S
JS
Coselli
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas; Division of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, Texas.
Charles D
CD
Collard
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas; Division of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, Texas. Electronic address: wpan@texasheart.org.
Wei
W
Pan
D000368:Aged; D000069059:Atorvastatin / Q000008:administration & dosage; D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069059:Atorvastatin