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Statins before CABG may reduce risk for mortality, stroke, AF
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Patients undergoing CABG had improved outcomes related to mortality, stroke and atrial fibrillation if they received statins before surgery, according to a new report.
Elmar W. Kuhn, MD, of the Heart Center at University of Cologne, Germany, and colleagues analyzed 32 CABG-related studies covering 36,053 patients (54.3% statin users) and four aortic valve replacement surgery-related studies covering 3,091 patients (33.7% statin users). They investigated outcomes related to mortality, MI, stroke, AF and renal failure.
In the 28 CABG studies that reported short-term mortality, overall mortality was lower for pre-surgery statin users compared with control patients (1.7% vs. 2.3%; P<.01). Patients who received statins before CABG had a 33% reduction in odds for mortality compared with those who did not receive statins (OR=0.67; 95% CI, 0.54-0.82).
In the 16 CABG studies that reported stroke, the incidence of stroke was lower for pre-surgery statin users compared with control patients (1.2% vs. 1.6%; P=.03). Patients who received statins before CABG had a 19% reduction in odds for stroke compared with those who did not receive statins (OR=0.81; 95% CI, 0.67-0.97).
Patients who received statins before CABG also had a lower incidence of AF compared with control patients (22.8% vs. 24.3%; P=.04). The researchers also observed a reduction in odds for AF among statin users (OR=0.72; 95% CI, 0.59-0.87).
Kuhn and colleagues did not identify the underlying mechanisms of the benefit of pre-CABG statin therapy on death, stroke and AF outcomes. “It remains unclear whether a primary and preventive effect on AF reduces the rate of postoperative stroke, thereby finally affecting patients’ mortality,” they wrote.
However, there was no difference in the odds for MI between patients who received statins before CABG and those who did not (OR=1.08; 95% CI, 0.92-1.27), although incidence of MI was higher among statin users overall (3.6% vs. 2.9%; P=.01). According to the researchers, one possible explanation is “different definitions of MI among all included studies.” There was also no difference in the incidence (8.5% vs. 9%; P=.21) or odds (OR=0.98; 95% CI, 0.85-1.13) for renal failure between pre-CABG statin therapy and no statin therapy.
The analysis revealed no difference for patients who did and did not receive statins before aortic valve replacement surgery related to odds for mortality (OR=0.72; 95% CI, 0.46-1.12), MI (OR=1.02; 95% CI, 0.52-1.99), stroke (OR=0.77; 95% CI, 0.45-1.32) or renal failure (OR=0.68; 95% CI, 0.41-1.11). None of the studies included in the meta-analysis reported AF outcomes in patients who underwent aortic valve replacement surgery.
Disclosure: The researchers report no relevant financial disclosures.
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