Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30 000 patients

Liakopoulos, Oliver J.; Choi, Yeong‐Hoon; Haldenwang, Peter Lukas; Strauch, Justus; Wittwer, Thorsten; Dörge, Hilmar; Stamm, Christof; Wassmer, Gernot; Wahlers, Thorsten

doi:10.1093/eurheartj/ehn198

Cited by 237 publications

(137 citation statements)

References 51 publications

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“…In a large meta-analysis (n = 31,725), preoperative statin exposure significantly reduced early mortality (OR = 0.57), stroke (OR = 0.74) and atrial fibrillation (OR = 0.6) after cardiac surgery [174]. In other study, which included 213,347 older patients who underwent major elective surgery, statin therapy was associated with 16% lower risk of AKI and 21% lower risk of mortality [175].…”

Section: Major Surgery and Statin Intolerancementioning

confidence: 95%

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Banach

Rizzo²,

Tóth

et al. 2015

Expert Opinion on Drug Safety

182

204

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Section: Major Surgery and Statin Intolerancementioning

confidence: 95%

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Banach

Rizzo²,

Tóth

et al. 2015

Expert Opinion on Drug Safety

182

204

View full text Add to dashboard Cite

“…Atorvastatin is also considered to have a superior affinity for cardiac cellular membrane than pravastatin, since atorvastatin is a lipophilic statin whereas pravastatin is a hydrophilic statin. Clinical efficacy of statins in AF: Most of the randomized trials 8,33,34) and meta-analyses 9,35,36) in large-scale clinical studies have shown similar results with respect to the beneficial effica- Figure 1. Survival curve free from AF recurrence after upstream therapy with statins in patients on antiarrhythmic drugs.…”

Section: Discussionmentioning

confidence: 92%

Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin

et al. 2011

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SummaryThere is little information available on the benefits of selection of statins as upstream therapy for the prevention of paroxysmal atrial fibrillation (AF). We compared the efficacy and safety of atorvastatin (A-group, n = 43) and pravastatin (P-group, n = 41) as upstream therapy in patients with paroxysmal AF and dyslipidemia. A total of 84 patients (45 men, mean age, 66 ± 9 years, mean follow-up, 49 ± 32 months) were retrospectively assigned to receive atorvastatin (n = 41;10 mg/day) or pravastatin (n = 43 ; 10 mg/day). Survival rates free from AF recurrence at 1, 6, 12, and 24 months were 93%, 74%, 60%, and 53% in A-group, and 88%, 49%, 37%, and 29%, respectively, in P-group (P = 0.029, Agroup versus P-group). Survival rates free from conversion to permanent AF at 12, 36, 60, and 90 months were 100%, 100%, 98%, and 95% in A-group, and 100%, 95%, 88%, and 83%, respectively, in P-group (P = 0.063, A-group versus P-group). Using a logistic regression model, atorvastatin was found to be associated with a significantly reduced risk of AF recurrence in comparison to pravastatin (unadjusted odds ratio [OR] = 0.27, 95% confidence interval 0.11-0.68, P = 0.005). This association remained significant after adjustment for potentially confounding variables (OR = 0.26, 95% CI 0.08-0.86, P = 0.027). Using a logistic regression model, atorvastatin was not associated with a significantly reduced risk of converting to permanent AF in comparison to pravastatin (unadjusted OR = 0.29, 95% CI 0.05-1.50, P = 0.138), but this association did show a significant difference after adjustment for potentially confounding variables in a multivariate model (OR = 0.08, 95% CI 0.06-0.96, P = 0.046). Adverse effects requiring discontinuation of statins were observed in 1 case (2%, myalgia) in A-group, and 1 case (2%, elevation in CPK level ≥ 500 IU/L) in P-group, respectively (P = NS, A-group versus P-group). Atorvastatin, a lipophilic statin, was considered to be more effective in preventing recurrence of paroxysmal AF and conversion to permanent AF than pravastatin, a hydrophilic statin. (Int Heart J 2011; 52: 359-365)

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“…[17] A subsequent Cochrane review that included 11 randomized trials in 984 participants undergoing (predominantly) CABG surgery [3] found that statins reduced the incidence of AF (OR: 0.40; 95% CI: 0.29-0.55) and led to a shorter intensive care unit (weighted mean difference, −3.39 [95% CI: −5.77 to −1.01] h) and hospital (weighted mean difference, −0.48 [95% CI: −0.85 to −0.11] days) stay, but no difference in mortality, MI, stroke or renal failure.…”

Section: The Evidence For Statinsmentioning

confidence: 99%

Does the use of statins improve outcomes in coronary artery bypass graft surgery?

McIlroy

Myles

2015

Expert Review of Cardiovascular Therapy

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Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30 000 patients

Abstract: Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials.

Cited by 237 publications

References 51 publications

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin

Does the use of statins improve outcomes in coronary artery bypass graft surgery?

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