European Heart Journal Advance Access originally published online on August 5, 2008
European Heart Journal 2008 29(19):2443-2444; doi:10.1093/eurheartj/ehn352
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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: reply
Department of Cardiothoracic Surgery
Heart Centre
University of Cologne
Kerpenerstrasse 62
Cologne
Germany
Email: oliver.liakopoulos{at}uk-koeln.de
Department for Medical Statistics, Informatics, and Epidemiology
University of Cologne
Cologne
Germany
Department of Cardiothoracic Surgery
Heart Centre
University of Cologne
Kerpenerstrasse 62
Cologne
Germany
We would like to thank Dr Takagi et al.1 for their comments that underscore the findings of our meta-analysis with regard to the favourable effect of statin treatment on the endpoint early all-cause mortality after cardiac surgery. In their systematic review,2 which exclusively included evidence from full-text publications of 19 542 cardiac surgery patients, the authors report a similar reduction in postoperative mortality following pooled analysis of crude odds ratios (ORs). Moreover, this favourable effect of a statin pre-treatment persisted even after accounting for adjusted ORs from included observational trials. Although this observation appears to further augment the benefits of a statin therapy prior to cardiac surgery, it should be taken into consideration that confounding variables adjusted for by multivariate analysis or propensity score matching varied among observational studies. Thus, the definite impact of a possible selection and treatment bias derived from this mainly observational data sets remains unclear even after meta-analysis and, especially, with regard to the unequal preoperative use of other known cardioprotective agents such as β-blockers and aspirin that favours statin pre-treated patients.
Only a randomized, controlled trial, with pre-specified statin agents, doses, and clearly defined perioperative treatment periods, will warrant equal distribution of confounding variables among treatment groups and allow definite conclusions about the independent effects of a preoperative statin therapy on early adverse outcomes in cardiac surgery patients. We hope that the present debate will stimulate the initiation of such a trial to investigate these clinically relevant and important questions.
References
- Liakopoulos OJ, Choi YH, Haldenwang PL, Strauch J, Wittwer T, Dorge 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).
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