The observational study included 180,478 veterans (95.6 percent men and 4.4 percent women) undergoing elective or emergent noncardiac surgery between Oct. 1, 2005 and Sept. 30, 2010. Data on statin use were collected on the day of or the day after surgery and patients underwent a 30-day postoperative follow-up. The main outcomes measures were all-cause 30-day mortality (primary outcome) and standardized 30-day cardiovascular and noncardiovascular outcomes.

The researchers found that 37.8 percent of patients had an active outpatient prescription for a statin, of whom 80.8 percent were prescribed simvastatin and 59.5 percent used moderate-intensity dosing, at the time of admission. Exposure to a statin on the day of or the day after surgery based on an inpatient prescription was noted in 31.5 percent of the cohort.

Among 48,243 propensity score–matched pairs of early perioperative statin-exposed and nonexposed patients, 30-day all-cause mortality was significantly reduced in exposed patients (relative risk [RR], 0.82; 95 percent confidence interval [CI], 0.75-0.89; p < 0.001; number needed to treat, 244; 95 percent CI, 170-432). Of the secondary outcomes, a significant association with reduced risk of any complication was noted (RR, 0.82; 95 percent CI, 0.79-0.86; p < 0.001; number needed to treat, 67; 95 percent CI, 55-87); all were significant except for the central nervous system and thrombosis categories, with the greatest risk reduction (RR, 0.73; 95 percent CI, 0.64-0.83) for cardiac complications.

“This observational cohort analysis reports that statin use on the day of and/or the day after noncardiac surgery was associated with lower 30-day all-cause mortality and reduction in a variety of postoperative complications (most notably cardiac), compared with nonuse,” writes Debabrata Mukherjee, MD, FACC, in an ACC.org Journal Scan. “Current evidence supports a protective effect of statins in the perioperative period, and the data presented in this study suggest a benefit of statins even when these medications are first administered in the immediate perioperative period. Until additional data are available, one could consider using the ACC/American Heart Association Pooled Cohort Equations Risk Calculator to choose which patients, in addition to those with established cardiovascular disease, would be candidates for statin therapy immediately before surgery.”

JAMA Intern Med 2016;Dec 19:[Epub ahead of print].

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Using data from ACC’s CathPCI Registry, Wassef Karrowni, MD, and colleagues examined 1,756,864 patients with acute coronary syndrome undergoing PCI. AKI developed in 157,386 (9.0 percent) of patients. These patients were older, more likely to be women and had a high prevalence of comorbidities such as diabetes mellitus and hypertension. About 24 percent of patients with AKI had chronic kidney disease at baseline. Patients with AKI had worse in-hospital outcomes.

Blood transfusion was given in 38,626 (2.2 percent) patients, mostly those with low hemoglobin at baseline or with bleeding. AKI developed in 35.1 percent of patients who were given a blood transfusion compared with 8.4 percent of patients who were not. The lower the baseline hemoglobin level, the higher the rate of AKI. In patients who received a blood transfusion for a bleeding event, the rate of AKI significantly increased across all preprocedure hemoglobin levels compared with those who did not receive a transfusion. Similar findings were found in those without a bleeding event.

Given that AKI is common following PCI and is associated with increased morbidity and mortality, as well as higher health care costs, the authors suggest that “greater efforts need to be implemented to first better define the population of patients in whom transfusion could be of benefit and also increase the awareness of the nonbenign nature of blood transfusion.”

Karrowni W, Vora AN, Dai D, et al. Circ Cardiovasc Interv. 2016;9:e003279 DOI: 10.1161/CIRCINTERVENTIONS.115.003279.

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Using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes and administrative claims data from nonfederal hospitals in California, Florida and New York, Michael Reznik, MD, and colleagues identified patients with ischemic stroke who underwent carotid endarterectomy (CEA) and carotid artery stenting (CAS) within 90 days of an ischemic stroke from 2005 to 2013. Outcomes were the number of days between stroke and CEA/CAS and the proportion of patients undergoing CEA/CAS within the recommended 14-day period.

Of the 16,298 patients identified, clinical characteristics were similar between patients who underwent carotid revascularization procedures within 90 days and those who did not. The median time frame from stroke to procedures progressively decreased from 25 days in 2005 to six days in 2013. The proportion of patients who underwent CEA and CAS within two weeks increased from 40 percent in 2005 to 73 percent in 2013.

“Although this trend is encouraging, efforts to further promote earlier revascularization in the U.S. may still be beneficial because there remains a high risk of recurrent stroke even within the recommended 14-day window,” writes Debabrata Mukherjee, MD, FACC, in an ACC.org Journal Scan.

Reznik M, Kamel H, Gialdini G, et al. Stroke 2016;Dec 6. DOI: 10.1161/STROKEAHA.116.015766.

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Researchers analyzed data from 6,739 women (mean age range from 44-63 years) with a 10-year ASCVD risk <7.5 percent from five large population-based cohorts in the U.S., Germany and the Netherlands. Median follow-up ranged from seven to 11.6 years. The primary outcome of interest was incident ASCVD, which included nonfatal myocardial infarction (MI), coronary heart disease (CHD) death, and stroke.

Overall results found CAC was present in 36.1 percent of the women. During the follow-up, 165 events occurred, including 64 nonfatal MIs, 29 CHD deaths and 72 strokes. Compared with the absence of CAC (CAC = 0), presence of CAC (CAC >0) was associated with an increased risk of ASCVD. The addition of CAC to traditional risk factors improved the C-statistic from 0.73 (95 percent CI, 0.69-0.77) to 0.77 (95 percent CI, 0.74-0.81) and provided a continuous net reclassification improvement index of 0.20 (95 percent CI, 0.09-0.31) for ASCVD prediction.

The investigators concluded that among women at low ASCVD risk, CAC was present in approximately one-third, and was associated with an increased risk of ASCVD and modest improvement in prognostic accuracy compared with traditional risk factors. They noted that further research is needed to assess the clinical utility and cost-effectiveness of this additional accuracy.

Kavousi M, Desai CS, Ayers C, et al. JAMA 2016;Nov 15. DOI: 10.1001/jama.2016.17020.

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