European Heart Journal Advance Access originally published online on May 27, 2008
European Heart Journal 2008 29(12):1548-1559; doi:10.1093/eurheartj/ehn198
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Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30 000 patients
1 Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany
2 Department of Cardiothoracic Surgery, Fulda Hospital, Fulda, Germany
3 Department of Thoracic and Cardiovascular Surgery, German Heart Institute, Berlin, Germany
4 Department for Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany
Received 25 February 2008; revised 14 April 2008; accepted 18 April 2008; online publish-ahead-of-print 28 May 2008.
* Corresponding author. Tel: +49 221 478 32451, Fax: +49 221 478 4186, Email: oliver.liakopoulos{at}uk-koeln.de
Aims: To determine the strength of evidence for preoperative statin use for prevention of adverse postoperative outcomes in patients undergoing cardiac surgery.
Methods and results: After literature search in major databases, 19 studies were identified [three RCT (randomized prospective clinical trials), 16 observational] that reported outcomes of 31 725 cardiac surgery patients with (n = 17 201; 54%) or without (n = 14 524; 46%) preoperative statin therapy. Outcomes that were analysed included early all-cause mortality (30-day mortality), myocardial infarction (MI), atrial fibrillation (AF), stroke and renal failure. Odds ratio (OR) with 95% confidence intervals (95%CI) were reported using fixed or random effect models and publication bias was assessed. Preoperative statin therapy resulted in a 1.5% absolute risk reduction (2.2 vs. 3.7%; P < 0.0001) and 43% odds reduction for early all-cause mortality (OR 0.57; 95%CI: 0.49–0.67). A significant reduction (P < 0.01) in statin pretreated patients was also observed for AF (24.9 vs. 29.3%; OR 0.67, 95%CI: 0.51–0.88), stroke (2.1 vs. 2.9%, OR 0.74, 95%CI: 0.60–0.91), but not for MI (OR 1.11; 95%CI: 0.93–1.33) or renal failure (OR 0.78, 95%CI: 0.46–1.31). Funnel plot and Egger’s regression analysis (P = 0.60) excluded relevant publication bias.
Conclusion: Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials.
Key Words: Meta-analysis • Hydroxymethylglutaryl-coenzyme A reductase inhibitors • Statins • Cardiac surgery • Clinical outcomes
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