European Heart Journal Advance Access originally published online on August 5, 2008
European Heart Journal 2008 29(19):2443; doi:10.1093/eurheartj/ehn351
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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
Department of Cardiovascular Surgery
Shizuoka Medical Center
762-1 Nagasawa, Shimizu-cho, Sunto-gun
Shizuoka 411-8611
Japan
Tel: +81 559 75 2000
Fax: +81 559 75 2725
Email: kfgth973{at}ybb.ne.jp
and on behalf of the following co-authors
We congratulate Liakopoulos et al.1 upon the publication of their meta-analysis and would be grateful that their result of early all-cause mortality strengthens that of our preceding meta-analysis.2 Their meta-analysis of crude odds ratio (OR) from 15 studies with 28 517 patients revealed a 43% reduction in mortality (OR 0.57; 95% confidence interval [CI] 0.49–0.67; P < 0.0001 for overall effect) in patients receiving statins before cardiac surgery. The 15 studies, however, included two studies presented at a scientific meeting (not full-text publication) and the study by Powell et al.3 in which the statin group included 14% on other lipid-lowering therapy. Furthermore, they astonishingly excluded their own study4 that completely meets the inclusion criteria of their meta-analysis. On the other hand, our meta-analysis2 included exclusively 13 full-text publication with 19 542 patients: the remaining 12 studies except for the above-mentioned three studies in the meta-analysis by Liakopoulos et al. plus their own study4 that was excluded in their meta-analysis. Pooled analysis of crude ORs from all 13 studies demonstrated a 45% reduction in mortality with preoperative statin therapy (OR 0.55; 95% CI 0.46–0.66; P < 0.0001 for overall effect)2 that is similar to the result by Liakopoulos et al. Six of the 10 observational studies included in our meta-analysis reported adjusted ORs for mortality by multivariate analysis or propensity score matching. When adjusted ORs from these six observational studies and crude ORs from the three randomized, controlled trials were pooled (representing 18 637 patients), preoperative statin therapy was associated with a 24% reduction in mortality (OR 0.76; 95% CI 0.46–0.90; P < 0.01 for overall effect).2 Additionally, pooled analysis of adjusted and crude ORs, respectively, from three observational studies and two randomized, controlled trials that enrolled patients undergoing coronary artery bypass graft surgery exclusively (representing 7205 patients) demonstrated a 41% reduction in mortality with preoperative statin therapy (OR 0.59; 95% CI 0.36–0.97; P = 0.04 for overall effect).2 In a meta-analysis of observational studies, to correct for and minimize selection bias that exists in observational studies, not crude but adjusted ORs would do better to be combined.
References
- Liakopoulos OJ, Choi YH, Haldenwang PL, Strauch J, Wittwer T, Dörge H, Stamm C, Wassmer G, Wahlers T. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients. Eur Heart J (2008) 29:1548–1559.
[Abstract/Free Full Text] - Takagi H, Kawai N, Takuya U. Preoperative statin therapy reduced postoperative all-cause mortality in cardiac surgery: a meta-analysis of controlled studies. J Thorac Cardiovasc Surg. (in press).
- Powell BD, Bybee KA, Valeti U, Thomas RJ, Kopecky SL, Mullany CJ, Wright RS. Influence of preoperative lipid-lowering therapy on postoperative outcome in patients undergoing coronary artery bypass grafting. Am J Cardiol (2007) 99:785–789.[CrossRef][Web of Science][Medline]
- Liakopoulos OJ, Dörge H, Schmitto JD, Nagorsnik U, Grabedünkel J, Schoendube FA. Effects of preoperative statin therapy on cytokines after cardiac surgery. Thorac Cardiovasc Surg (2006) 54:250–254.[CrossRef][Web of Science][Medline]
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