Effect of preoperative statin therapy on patients undergoing isolated and combined valvular heart surgery.

Abstract

BACKGROUND:

It is unknown whether patients undergoing valve surgery benefit from preoperative statin therapy. We examined the effects of statin treatment in a large group of patients undergoing valve surgery.

METHODS:

Between October 2001 and May 2008, a total of 10,061 patients underwent isolated or combined valve surgery at our institution. Patients were divided into those who received preoperative statin therapy (group 1, n = 4,216) versus those who did not receive statin therapy (group 2, n = 5,538). Patients in whom preoperative statin therapy status was unknown (n = 307) were excluded. Follow-up survival information was available in all patients.

RESULTS:

Group 1 patients had more comorbidities, were more likely to undergo concomitant coronary artery bypass grafting (46.0% versus 20.7%; p < 0.001), and had a higher mean EuroSCORE predicted risk of mortality (12.4% +/- 13.5% versus 11.5% +/- 13.9%; p = 0.002). Patients receiving preoperative statin therapy had a higher incidence of low cardiac output syndrome (8.4% versus 6.0%; p < 0.001) and the combined cardiac outcome of myocardial infarction, low cardiac output syndrome, and 30-day mortality (11.8% versus 9.6%; p < 0.001) by univariate analysis. Multivariable analyses, however, revealed no significant effect of statin therapy on perioperative cardiac outcomes. Cox multivariable regression revealed no significant effect of statin therapy on long-term survival in the entire patient cohort, but statin therapy was associated with a long-term survival benefit (hazard ratio, 0.81; 95% confidence interval, 0.70 to 0.93; p = 0.003) in patients who underwent concomitant coronary artery bypass grafting.

CONCLUSIONS:

Our large series failed to detect a protective effect of preoperative statin therapy on perioperative outcomes or long-term survival in patients undergoing isolated valve surgery. Valve patients undergoing concomitant coronary artery bypass grafting, however, appear to receive a long-term survival benefit from statins.

• Authors: Michael A Borger, Joerg Seeburger, Thomas Walther, Franka Borger, Ardawan Rastan, Torsten Doenst, Friedrich W Mohr
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 89 Issue 3 Pg. 773-9; discussion 779-80 (Mar 2010) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 20172126 (Publication Type: Controlled Clinical Trial, Journal Article)
• Copyright: 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aged
• Cardiac Surgical Procedures (mortality)
• Coronary Artery Bypass
• Female
• Heart Valves (surgery)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage)
• Male
• Middle Aged
• Postoperative Complications
• Preoperative Care
• Survival Rate