Postoperative Myocardial Injury and Inflammation is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients

Bass, Anne R.; Szymonifka, Jackie; Rondina, Matthew T.; Bogardus, Margaret H.; Scott, Mitchell G.; Woller, Scott C.; Stevens, Scott M.; Eby, Charles S.; Merritt, Kerri; Valle, Alejandro González Della; Moskowitz, Gerard W.; Flores, Eva Iglesias; Gage, Brian F.

doi:10.1007/s11420-017-9577-1

Cited by 9 publications

(13 citation statements)

References 53 publications

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“…Twenty-five trials (4698 patients) included elective cardiac surgery patients, with coronary artery bypass grafting surgery as the most represented procedure, performed in 72.29% of the patients. Ten trials (3502 patients) were performed in non-cardiac surgery setting [ 2 , 3 , 17 , 19 , 29 , 33 , 34 , 39 , 41 , 43 ], in particular: 2 in elective non-cardiac surgery, 2 trials in elective vascular surgery, 1 in elective lung resection surgery, 1 in elective orthopedic surgery, 1 in elective esophagectomy, 1 in elective colorectal surgery, and 2 in urgent abdominal surgery.…”

Section: Resultsmentioning

confidence: 99%

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Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Putzu

Silva

Almeida

et al. 2018

Ann. Intensive Care

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BackgroundThe effects of perioperative statin therapy on clinical outcome after cardiac or non-cardiac surgery are controversial. We aimed to assess the association between perioperative statin therapy and postoperative outcome.MethodsElectronic databases were searched up to May 1, 2018, for randomized controlled trials of perioperative statin therapy versus placebo or no treatment in adult cardiac or non-cardiac surgery. Postoperative outcomes were: myocardial infarction, stroke, acute kidney injury (AKI), and mortality. We calculated risk ratio (RR) or odds ratio (OR) and 95% confidence interval (CI) using fixed-effects meta-analyses. We performed meta-regression and subgroup analyses to assess the possible influence of statin therapy regimen on clinical outcomes and trial sequential analysis to evaluate the risk of random errors and futility.ResultsWe included data from 35 RCTs involving 8200 patients. Perioperative statin therapy was associated with lower incidence of postoperative myocardial infarction in non-cardiac surgery (OR = 0.44 [95% CI 0.30–0.64], p < 0.0001), but not in cardiac surgery (OR = 0.93 [95% CI 0.70–1.24], p = 0.61) (psubgroup = 0.002). Higher incidence of AKI was present in cardiac surgery patients receiving perioperative statins (RR = 1.15 [95% CI 1.00–1.31], p = 0.05), nonetheless not in non-cardiac surgery (RR = 1.52 [95% CI 0.71–3.26], p = 0.28) (psubgroup = 0.47). No difference in postoperative stroke and mortality was present in either cardiac or non-cardiac surgery. However, low risk of bias trials performed in cardiac surgery showed a higher mortality with statins versus placebo (OR = 3.71 [95% CI 1.03–13.34], p = 0.04). Subgroup and meta-regression analyses failed to find possible relationships between length of statin regimens and clinical outcomes. Trial sequential analysis suggested no firm conclusions on the topic.ConclusionsPerioperative statins appear to be protective against postoperative myocardial infarction in non-cardiac surgery and associated with higher AKI in cardiac surgery. Possible positive or even negative effects on mortality could not be excluded and merits further investigations. Currently, no randomized evidence supports the systematic administration of statins in surgical patients.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0441-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…In 13 cases, we received further outcomes’ data from the authors [ 6 , 14 , 17 , 19 – 22 , 24 , 27 , 30 , 32 – 34 ].…”

Section: Resultsmentioning

confidence: 99%

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Putzu

Silva

Almeida

et al. 2018

Ann. Intensive Care

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“…Twenty-two patients (11 in the perioperative statin group and 11 in the control group) were included, none of whom experienced MI, stroke, transient ischemic attack, atrial fibrillation or death. Nonetheless, the study was underpowered to reveal the effects of perioperative atorvastatin on patient outcomes after orthopaedic surgery [35], and it was therefore not included in our analysis. Ultimately, our analysis included 12 studies, five of which focused on populations that underwent noncardiovascular surgery, five of which assessed populations that underwent noncardiac vascular surgery, and two of which investigated populations that underwent noncardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Sun

Diao

et al. 2018

Annals of Medicine

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This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery. Key Messages Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

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“…The Post-Operative Statin for Thromboprophylaxis & Cardiovascular Outcomes Protection (POST-OP) trial based in New York, aimed to conduct a 30-patient trial for statin-naïve patients over 65 with hip fracture, randomised to atorvastatin 40 mg vs. placebo, and aimed to recruit 1000 patients to examine anti-inflammatory effects and heart injury. This pilot study was published after only recruiting four hip fracture patients, with the feasibility of performing a large trial questioned due to: (i) ethical concerns of assigning patients with pre-morbid cardiac disease to placebo; (ii) pre-existing statin use in 40% of the population; and (iii) multiple co-morbidities that clashed with inclusion criteria [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Preadmission Statin Prescription and Inpatient Myocardial Infarction in Geriatric Hip Fracture

Tarrant

Kim

McDonogh

et al. 2021

JCM

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Statins have been shown to reduce myocardial infarction (MI) in cardiac and vascular surgery. MI is common in hip fracture. This study aims to investigate whether statins decrease MI in hip fracture surgery and reduce mortality resulting from MI. Patients aged 65 years and above with a low-energy hip fracture were identified between January 2015 and December 2017. Demographics, comorbidities, predictive scores, medications and outcomes were assessed retrospectively. The primary outcome was inpatient MI. The secondary outcome was inpatient mortality resulting from MI, for which fatal and non-fatal MI were modelled. Regression analysis was conducted with propensity score weighting. Hip fracture occurred in 1166 patients, of which 391 (34%) were actively taking statins. Thirty-one (2.7%) patients were clinically diagnosed with MI. They had a higher inpatient mortality than those who did not sustain an MI (35% vs. 5.3%, p < 0.0001). No reduction was seen between statin use and the occurrence of MI (OR = 0.97, 95% CI: 0.45–2.11; p = 0.942) including Fluvastatin-equivalent dosage (OR = 1.00, 95% CI: 0.96–1.03, p = 0.207). Statins were not associated with having a non-fatal MI (OR 1.47, 95% CI: 0.58-3.71; p = 0.416) or preventing fatal MI (OR = 0.40, 95% CI: 0.08–1.93; p = 0.255). Preadmission statin use and associations with clinically diagnosed inpatient MI or survival after inpatient MI were not able to be established.

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Postoperative Myocardial Injury and Inflammation is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients

Abstract: NCT02197065.

Cited by 9 publications

References 53 publications

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Preadmission Statin Prescription and Inpatient Myocardial Infarction in Geriatric Hip Fracture

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