Preoperative Statin Treatment Is Not Associated with Reduced Postoperative Mortality or Morbidity in Patients Undergoing Isolated Valve Surgery
DOI:
https://doi.org/10.1532/hsf.2119Abstract
Introduction: Previous studies have shown that statin use before coronary surgery decreases the mortality and morbidity. This benefit was not clearly detected in isolated valve surgery. The aim of this study was to assess the effect of preoperative statin therapy on postoperative complications and mortality in a large group of patients undergoing valve surgery.
Patients, Materials, and Methods: The data of consecutive patients undergoing isolated valve replacement during an 8-year period were retrospectively reviewed from a prospective database. Mortality was compared between the patients who received preoperative statin (statin group [SG]) and those who did not receive statin (control group [CG]) after adjustment on EuroSCORE. Main postoperative complications and mortality were compared between the 2 groups by using a propensity score analysis.
Results: During the study period, 1115 patients were prospectively included, 796 in the CG group and 319 in the SG. The SG patients were significantly older, had more cardiovascular risk factors (hypertension, diabetes, and weight) than the CG patients, and benefited from more elective surgery or aortic valve replacement. No difference in mortality was found between the groups: 4.4% in the SG and 4.5% in the CG, P = .95. Multivariate analysis also revealed no effect of statin on mortality, according to the type of surgery (aortic valve surgery alone or any kind of valve surgery)
(P = .93), or the elective or urgent nature of the surgery
(P = .67). Statin did not predict mortality after stratification with the EuroSCORE or the Parsonnet score. No difference was found between the 2 groups for postoperative complications (24-hour bleeding, atrial fibrillation, renal failure, length of mechanical ventilation, or hospital stay) and mortality after adjustment with a propensity score.
Discussion: This study found no difference in mortality or morbidity associated with preoperative statin therapy after isolated valve surgery.
References
Ali IS, Buth KJ. 2005. Preoperative statin use and outcomes following cardiac surgery. Int J Cardiol 103:12-8.
Allou N, Augustin P, Dufour G, et al. 2010. Preoperative statin treatment is associated with reduced postoperative mortality after isolated cardiac valve surgery in high-risk patients. J Cardiothorac Vasc Anesth 24: 921-6.
Angeloni E, Melina G, Benedetto U, et al. 2011. Statins improve outcome in isolated heart valve operations: a propensity score analysis of 3,217 patients. Ann Thorac Surg 92:68-73.
Baigent C, Keech A, Kearney PM, et al. 2005. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 366:1267–78. Group author name: Cholesterol Treatment Trialists’ (CTT) Collaborators.
Beckman JA, Liao JK, Hurley S, et al. 2004. Atorvastatin restores endothelial function in normocholesterolemic smokers independent of changes in low-density lipoprotein. Circ Res 95:217-23.
Berwanger O, Le Manach Y, Suzumura EA, et al. 2016. Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study. Eur Heart J 37:177-85.
Borger MA, Seeburger J, Walther T, et al. 2010. Effect of preoperative statin therapy on patients undergoing isolated and combined valvular heart surgery. Ann Thorac Surg 89:773-9
Chello M, Anselmi A, Spadaccio C, et al. 2007. Simvastatin increases neutrophil apoptosis and reduces inflammatory reaction after coronary surgery. Ann Thorac Surg 83:1374-80.
Chello M, Goffredo C, Patti G, et al. 2005. Effects of atorvastatin on arterial endothelial function in coronary bypass surgery. Eur J Cardiothorac Surg 28:805-10.
Cheng X, Hu Q, Liu Z, Tang X. 2015. Preoperative statin therapy decreases early mortality in patients undergoing isolated valve surgery: result from a meta-analysis. J Cardiothorac Vasc Anesth 29:107-14.
Fedoruk LM, Wang H, Conaway MR, Kron IL, Johnston KC. 2008. Statin therapy improves outcomes after valvular heart surgery. Ann Thorac Surg 85: 1521-5; discussion 1525-6.
Folkeringa RJ, Tieleman RG, Maessen JG, Prins MH, Nieuwlaat R, Crijns HJ. 2011. Statins do not reduce atrial fibrillation after cardiac valvular surgery: a single centre observational study. Neth Heart J 19:17-23.
Guay J, Ochroch EA. 2014. Effects of adding statins before surgery on mortality and major morbidity: a meta-analysis. J Cardiothorac Vasc Anesth 28:255-66.
Hindler K, Shaw AD, Samuels J, Fulton S, Collard CD, Riedel B. 2006. Improved postoperative outcomes associated with preoperative statin therapy. Anesthesiology 105:1260-72; quiz 1289-90.
Katznelson R, Djaiani GN, Borger MA, et al. 2009. Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery. Anesthesiology 110: 67-73.
Koenig MA, Grega MA, Bailey MM, et al. 2009. Statin use and neurologic morbidity after coronary artery bypass grafting: a cohort study. Neurology 73:2099-106.
Kuhn EW, Liakopoulos OJ, Stange S, et al. 2013. Meta-analysis of patients taking statins before revascularization and aortic valve surgery. Ann Thorac Surg 96:1508-16.
Layton JB, Kshirsagar AV, Simpson RJ Jr, et al. 2013. Effect of statin use on acute kidney injury risk following coronary artery bypass grafting. Am J Cardiol 111:823-8.
Liakopoulos OJ, Choi YH, Haldenwang PL, et al. 2008. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients. Eur Heart J 29:1548-59.
Mannacio VA, Iorio D, De Amicis V, Di Lello F, Musumeci F. 2008. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial. J Thorac Cardiovasc Surg 136:1541-8.
Martínez-Comendador J, Alvarez JR, Mosquera I, et al. 2009. Preoperative statin treatment reduces systemic inflammatory response and myocardial damage in cardiac surgery. Eur J Cardiothorac Surg 36:998-1005.
Martínez-Comendador J, Alvarez JR, Sierra J, Teijeira E, Adrio B. 2013. Preoperative statin therapy in cardiac surgery is more effective in patients who display preoperative activation of the inflammatory system. Tex Heart Inst J 40:42-9.
Naci H, Brugts JJ, Fleurence R, Ades AE. 2013. Dose-comparative effects of different statins on serum lipid levels: a network meta-analysis of 256,827 individuals in 181 randomized controlled trials. Eur J Prev Cardiol 20:658-70.
Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9-13.
Pan W, Pintar T, Anton J, Lee VV, Vaughn WK, Collard CD. 2004. Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. Circulation 110(11 suppl 1):II45-9.
Parsonnet V, Dean D, Bernstein AD. 1989. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 79(6 Pt 2):I3-12.
Patti G, Chello M, Candura D, et al. 2006. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation 114:1455-61.
Prowle JR, Calzavacca P, Licari E, et al. 2012. Pilot double-blind, randomized controlled trial of short-term atorvastatin for prevention of acute kidney injury after cardiac surgery. Nephrology (Carlton) 17:215-24.
Subramaniam K, Koch CG, Bashour A, et al. 2008. Preoperative statin intake and morbid events after isolated coronary artery bypass grafting. J Clin Anesth 20:4-11.
Thielmann M, Neuhäuser M, Marr A, et al. 2007. Lipid-lowering effect of preoperative statin therapy on postoperative major adverse cardiac events after coronary artery bypass surgery. J Thorac Cardiovasc Surg 134:1143-9
