Outcomes Associated With Preoperative Statin Therapy
What are the effects of preoperative statin therapy on cardiovascular events in the first 30 days after noncardiac surgery?
This was an international, prospective, cohort study of adult patients having noncardiac surgery. Data regarding the use of cardiovascular drugs were collected before (>24 hours to 7 days, ≤24 hours) and after surgery (first 3 days). The primary outcome was a composite of all-cause mortality, myocardial injury after noncardiac surgery, or stroke at 30 days after surgery. To estimate the effect of preoperative statin usage on outcomes, the authors undertook propensity score analyses. The authors estimated the probability of patients receiving a statin preoperatively (i.e., any usage during the 7 days before surgery). Patients who used a statin before surgery were matched up to two patients who did not receive a statin.
The matched population consisted of 2,845 patients (18.4%) treated with a statin and 4,492 (29.0%) controls. Despite matching, standardized differences remained in >10% in five preoperative variables. The 30-day primary outcome was observed in 1,614 patients in the matched cohort (11.8%). After adjustment for potential confounding factors, statin use was associated with a significantly lower risk of the primary outcome (relative risk, 0.83; 95% confidence interval, 0.73-0.95; p = 0.007). Although statins were associated with significantly lower risk of all-cause mortality, myocardial injury after noncardiac surgery, and cardiovascular mortality, there were no statistically significant differences in the risk of myocardial infarction or stroke.
Preoperative statin therapy is independently associated with a lower risk of cardiovascular outcomes at 30 days.
This is an important analysis of >15,000 patients undergoing noncardiac surgery, which corroborates findings from other observational studies that have examined outcomes associated with statins in the perioperative setting. As the authors acknowledge, their results require confirmation in a large randomized trial.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Clinical Topic Collection: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Nonstatins, Novel Agents, Statins, Interventions and ACS
Keywords: Acute Coronary Syndrome, Cardiac Surgical Procedures, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Outcome Assessment (Health Care), Perioperative Period, Risk Management, Secondary Prevention, Stroke, Surgical Procedures, Operative
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