Preoperative Rosuvastatin Protects Patients with Coronary Artery Disease Undergoing Noncardiac Surgery

Abstract

Objectives: We explored whether preoperative rosuvastatin could protect the cardiac health of patients with coronary artery disease undergoing emergency, noncardiac surgery. Methods: We randomized 550 noncardiac emergency surgery patients with stable coronary artery disease on long-term statin therapy to treatment with and without preoperative rosuvastatin. All patients received rosuvastatin after surgery. We evaluated the incidence of myocardial necrosis and major adverse cardiovascular and cerebrovascular events (MACCE) 30 days and 6 months after surgery. Results: Creatinine kinase-myocardial band (CK-MB) isoform elevations occurred less frequently 12 and 24 h after noncardiac emergency surgery in the experimental group than in the control group (p = 0.029). After surgery, the incidence of MACCE was also lower in the experimental group than in the control group (p = 0.019). The difference was mainly due to the incidence of perioperative myocardial infarction (p = 0.029). Multivariable analysis found that rosuvastatin reload reduced the incidence of MACCE 52% 6 months after surgery (p = 0.03). Conclusions: Preoperative rosuvastatin reload therapy decreases the incidence of myocardial necrosis and MACCE after noncardiac emergency surgery in patients with stable coronary artery disease on long-term statin therapy.

Statin Reloading before Noncardiac Surgery: A Simple, Safe and Effective Approach for Reducing the Risk of Perioperative Myocardial Infarction

“…In fact, statin reloading with rosuvastatin has been associated with a reduction in ischemia-reperfusion injury after cardiac surgery in an animal model [14]. The results of the study by Xia et al [10] are consistent with these experimental observations and provide further evidence for the introduction of a simple and potentially effective additional therapeutic intervention in perioperative clinical practice. At present, noncardiac surgery is increasingly performed in elderly patients with coronary artery disease who may already be on statin therapy.…”

“…In particular, Xia et al [10] considered a large cohort of patients with stable chronic coronary artery disease on long-term statin treatment requiring emergency noncardiac surgery. These high-risk patients were randomized to receive either 20 mg of rosuvastatin or a matching placebo just 2 h before the emergency intervention.…”

Myocardial injury after noncardiac surgery

“…The established effect of statins in reducing cardiovascular mortality in the nonsurgical population [70] has also been demonstrated perioperatively in decreasing major adverse cardiac events (MACE) and mortality, both in randomized trials [71,72] as well as in large observational studies [73,74,75 & ]. In a recent observational study of the VISION data, patients receiving statins preoperatively were shown to have a significantly lower risk of all-cause mortality than a matched population (RR 0.58; 95% CI 0.40-0.83; an absolute risk reduction of 2.0%; 95% CI 0.5-3.2%) [75 & ].…”

O efeito das estatinas na prevenção de complicações pós-operatórias em pacientes adultos submetidos a cirurgias cardíaca e não-cardíaca: revisão sistemática e metanálise com análise sequencial de estudos randomizados

“…A busca nas bases de dados resultou em 8376 referências. Destas, 35 preencheram os critérios de inclusão e foram incluídas na análise, totalizando 8200 pacientes 35,36,39,40,[104][105][106][107][108]117, . A Figura 1 apresenta o fluxograma do estudo referente à busca na literatura, conforme disponibilizado na publicação da recomendação PRISMA 154 .…”

“…Metanálise recente em cirurgia cardíaca mostrou que estudos antigos e de menor qualidade sugerem efeitos protetores das estatinas, enquanto estudos mais recentes e de maior qualidade indicam efeitos deletérios na função renal 37 . Em cirurgia nãocardíaca, parte representativa dos dados advém de estudos observacionais 31,38 e da população de cirurgia vascular 33 , sendo que as metanálises disponíveis até o momento não comtemplam dois importantes estudos randomizados recentes que somam mais de 1000 pacientes no âmbito de cirurgia geral 39,40 .…”