Effect of Perioperative Statins on Death, Myocardial Infarction, Atrial Fibrillation, and Length of Stay

Abstract

Objective: To assess the influence of perioperative statin treatment on the risk of death, myocardial infarction, atrial fibrillation, and hospital and intensive care unit length of stay in statin-naive patients undergoing cardiac or noncardiac surgery. Data Sources: MEDLINE via PubMed, EMBASE, Biosis, and the Cochrane Central Register of Controlled Trials via Ovid. Additional studies were identified through hand searches of bibliographies, trial Web sites, and clinical experts. Randomized controlled trials reporting the effect of perioperative statins in statin-naive patients undergoing cardiac and noncardiac surgery were included. Study Selection: Two investigators independently selected eligible studies from original research published in any language studying the effects of statin use on perioperative outcomes of interest. Data Extraction: Two investigators performed independent article abstraction and quality assessment. Data Synthesis: Fifteen randomized controlled studies involving 2292 patients met the eligibility criteria.Random-effects meta-analyses of unadjusted and adjusted data were performed according to the method described by DerSimonian and Laird. Perioperative statin treatment decreased the risk of atrial fibrillation in patients undergoing cardiac surgery (relative risk [RR], 0.56; 95% CI, 0.45 to 0.69; number needed to treat [NNT], 6). In cardiac and noncardiac surgery, perioperative statin treatment reduced the risk of myocardial infarction (RR, 0.53; 95% CI, 0.38 to 0.74; NNT, 23) but not the risk of death (RR, 0.62; 95% CI, 0.34 to 1.14). Statin treatment reduced mean length of hospital stay (standardized mean difference, −0.32; 95% CI, −0.53 to −0.11) but had no effect on length of intensive care unit stay (standardized mean difference, −0.08; 95% CI, −0.25 to 0.10).Conclusions: Perioperative statin treatment in statinnaive patients reduces atrial fibrillation, myocardial infarction, and duration of hospital stay. Wider use of statins to improve cardiac outcomes in patients undergoing high-risk procedures seems warranted.

Relevancy of High Dose Statins Application Before and After Myocardium Revascularization

“…Описанные противовоспалительные механизмы, поло-жительное влияние на функцию эндотелия, прогноз боль-ных, антиаритмическое действие статинов позволяют сделать вывод о целесообразности назначения препара-тов этой группы, в частности аторвастатина, всем канди-датам на КШ, независимо от уровня ХС ЛНП [18].…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…111 At 6-month follow-up, atorvastatin significantly reduced the incidence of cardiac events (8% vs. 26%; P ¼ 0.03). In patients in whom statins were introduced before intervention, two meta-analyses showed a significant reduction in the risk of post-operative myocardial infarction following invasive procedures, 112,113 however, these meta-analyses included more clinical trials relating to cardiac surgery or percutaneous procedures than to non-cardiac surgery. All-cause post-operative mortality was not reduced in most series, except in one observational study that used propensity score adjustment to account for differences in patient characteristics according to the treatment.…”

Statin withdrawal after major noncardiac surgery: Risks, consequences, and preventative strategies

“…Our analysis also found statistically significant reductions in the risk of MI associated with perioperative statin use in both cardiac and noncardiac surgery (risk reduction [RR] 0.53, 95% CI 0.38-0.74) and atrial fibrillation in statin-naive patients undergoing cardiac surgery (RR 0.56, 95% CI 0.45-0.69). 31 Taken together, a large volume of evidence supports the use of statins in surgical settings.…”

“…In our recent systematic review, we were unable to provide refined estimates of these important side effects owing to differences in definition, variations in screening, and absence of standardized cutoffs used in studies. 31 Finally, an important reason for failing to resume postoperative statins is that many physicians simply fail to recognize the perioperative importance of these agents.…”