STICS: Does Perioperative Statin Treatment Reduce Complications After Cardiac Surgery?
High-dose statin treatment around the time of cardiac surgery does not reduce the rate of in-hospital complications after cardiac surgery, according to the results of the STICS Trial presented Sept. 2 during ESC Congress 2014.The STICS trial, a collaborative project between the National Centre for Cardiovascular Diseases at the Fuwai Hospital in Beijing, and the University of Oxford, included 1,922 patients who were undergoing elective cardiac surgery. Patients were randomized to receive either rosuvastatin (20 mg daily) or placebo, starting up to eight days before surgery and continuing until the fifth postoperative day.
Overall results showed compliance with the study treatment to be high (98 percent at the end of the scheduled treatment period) and allocation to the high-dose rosuvastatin regimen reduced cholesterol by 25 percent compared with placebo by 48 hours after surgery (p <0.0001). However, there were no differences between the rosuvatatin and placebo groups in the primary endpoints of new-onset of atrial fibrillation (21 percent vs. 20 percent, respectively; p= 0.72) or troponin I serum levels (p = 0.72). Further, study investigators noted that prespecified subgroup analyses did not identify any patient groups that benefited from perioperative statin use, and the treatment did not have any beneficial impact on secondary outcomes such as length of hospital stay, major in-hospital cardiac or cerebrovascular events, left ventricular function and plasma creatinine.
According to Zhe Zheng, MD, PhD, deputy director of cardiovascular surgery at the Fuwai Hospital, Chinese Academy of Medical Sciences in Beijing, China, and co-lead investigator of the STICS Trial, these new results could have important implications for perioperative practice and cardiac surgery guidelines. The results “show that initiating high-dose statin therapy in the perioperative period in order to avoid common postoperative complications is not warranted,” he said "They also show that, in subjects randomized to placebo, stopping statin therapy in the perioperative period does not have a negative impact on such complications."
"The lack of benefit in the STICS Trial is a bit of a surprise," said Barbara Casadei, MD, DPhil, from the John Radcliffe Hospital, University of Oxford, UK. "Previous studies suggested that short-term perioperative statin treatment may be beneficial in this regard; however, STICS offers definitive evidence against this notion. Overall, STICS reinforces the need to carry out large trials to confirm the results of smaller studies in selected groups of patients."
Keywords: Cholesterol, Postoperative Complications, Ventricular Function, Left, Troponin I, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Perioperative Period, Atrial Fibrillation, Creatinine, Cardiac Surgical Procedures, Length of Stay
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