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A statin before CABG has benefits: Cochrane Review

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients having coronary artery bypass grafting (CABG) have fewer postoperative heart rhythm complications and recover faster if they are pretreated with a statin, according to a Cochrane Review by researchers at the University of Cologne in Germany.

The “potential benefit of a preoperative statin therapy for other patient subgroups (i.e. heart valve surgery, etc.) remains unclear until further evidence from larger-sized clinical trials becomes available in the future,” lead researcher Oliver J. Liakopoulos noted in an email to Reuters Health.

He added: “Based on the included studies of our analysis and the high variability of the duration and dose of a statin therapy among these studies, the optimal statin treatment regimen before surgery is still unknown.”

Nonetheless, Dr. LIakopoulos said, based on the results of previous studies and in compliance with the updated guidelines of the American Heart Association patients who are scheduled for CABG who aren’t on a statin “should be started immediately before surgery without discontinuing the statin therapy in the close perioperative period unless contraindicated.”

For the Cochrane Review, the researchers analyzed data from 11 randomized controlled trials dating from 1999 to 2010 with a total of 984 patients having on- or off-pump cardiac surgery. These trials compared any statin treatment before cardiac surgery (mainly CABG), for any given duration and dose, to no preoperative statin therapy (standard of care) or placebo.

Pooled analysis showed that statin pre-treatment before the surgery reduced the incidence of postoperative atrial fibrillation (odds ratio 0.40; p<0.01), but failed to influence short-term death rates (OR 0.98; p=0.98) or postoperative stroke (OR 0.70; p=0.67).

Also, patients who received statin therapy before surgery tended to leave the ICU about three and a half hours sooner and left the hospital about a half day sooner than patients who did not. Statin therapy before cardiac surgery didn’t lead to a marked reduction in myocardial infarction (OR 0.52) or renal failure (OR 0.41).

“These results were unaffected after subgroup analysis,” the study team notes. They say no major or minor perioperative statin side-effects were reported from the trials investigating this safety endpoint.

The authors emphasize in their report that the most beneficial individual statin and the most effective timing of administration before surgery remains unanswered. “This is even more important,” they write, “when taking into account that recent evidence suggests improved clinical outcomes with a short-term and high-dose statin treatment (recapture therapy) prior to percutaneous coronary interventions (PCI) in patients that are on a chronic statin therapy; a finding that may have highly relevant clinical implications also for the improvement of outcomes of cardiac surgery patients.”


Preoperative statin therapy for patients undergoing cardiac surgery

Cochrane Database of Systematic Reviews 2012.