Statin Therapy in the Reduction of Cardiovascular Events in Patients Undergoing Intermediate‐Risk Noncardiac, Nonvascular Surgery

Abstract

(MI). A stepwise logistic regression with adjustment using propensity scores was performed to determine if statin therapy was independently associated with the risk reduction of adverse postoperative cardiovascular outcomes. Results: We identified 752 patients. Seventy-five of them (9.97%) developed composite end points; 10 (1.33%) had in-hospital nonfatal MI, 44 (5.85%) developed AF, and 35 (4.65%) died within 30 days. The 30-day all-cause mortality was 31/478 (6.48%) among statin nonusers vs 4/274 (1.45%) for statin users (P < 0.002). As compared with nonusers, patients on statin therapy had a 5-fold reduced risk of 30-day all-cause mortality. Statin therapy was associated with decreased CEP after adjusting for baseline characteristics, with a propensity score to predict use of statins (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.30-0.97, P = 0.039). After further adjustment for propensity score, diabetes mellitus, percutaneous coronary intervention, and prior coronary artery bypass grafting, statin therapy proved beneficial (OR: 0.51, 95% CI: 0.28-0.92, P = 0.026). Conclusions: Statin use in the perioperative period was associated with a reduction in cardiovascular adverse events and 30-day all-cause mortality in patients undergoing intermediate-risk NCNVS. IntroductionDespite advances in surgical techniques and medical management, cardiovascular complications remain the most common cause of postoperative morbidity and mortality in patients undergoing noncardiac surgery. 1 Patients with perioperative myocardial infarctions (MI) have an in-hospital mortality of 15% to 25%. 2,3 The pathophysiology of perioperative MI is complex. It can be related to myocardial

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…General The relationship between measures of resting LV systolic function (most commonly LVEF) and perioperative events has been evaluated in several studies of subjects before noncardiac surgery. 56,58,[146][147][148][149][150][151][152][153][154][155][156][157][158][159][160][161] These studies demonstrate an association between reduced LV systolic function and perioperative complications, particularly postoperative HF. The association is strongest in patients at high risk for death.…”

3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY

“… 303 In a retrospective cohort that included 752 patients submitted to nonvascular surgeries, the authors demonstrated a reduction in the combined outcome of nonfatal MI, AF, and mortality in a period of 30 days in patients using statins. 304 Recently, in an analysis of the patients included in the VISION study, 305 Berwanger et al 306 evaluated 2,842 patients receiving statins and 4,492 patients without statins. They compared the occurrence of mortality, isolated elevation of troponin levels (defined as troponin increased levels, without MI or other cause), and stroke in a period of 30 days by using propensity score matching.…”

Total knee arthroplasty: improving outcomes with a multidisciplinary approach

“…Several large cohort meta-analyses have proven that statins significantly reduce the risk for mortality (RR 0.50) and MI (RR 0.53) in the immediate postoperative period. 51 – 53 More interestingly, a 10-year, retrospective study demonstrated a sizable reduction for revision total hip arthroplasty (THA) due to aseptic loosening (RR 0.36). 54 However, follow-up studies have reported that these results may be due to flawed study designs.…”