Preoperative statin use in patients undergoing thoracic aortic aneurysm surgery was associated with a higher rate of postoperative renal failure requiring dialysis (2.8% vs 0.88%, p=0.02).
Observational (n=1,839)
No
Does preoperative statin therapy improve outcomes or reduce mortality in patients undergoing thoracic aorta replacement for aortic aneurysms?
Preoperative statin therapy in patients undergoing thoracic aortic aneurysm surgery does not improve intermediate-term survival or reduce aortic reinterventions, but is associated with an increased risk of postoperative acute kidney injury requiring dialysis.
Absolute Event Rate: 2.8% vs 0.88%
p-value: p=0.02
Abstract Background Patients undergoing surgery for thoracic aortic aneurysms receive statin therapy out of proportion to cardiovascular comorbidity. We sought to determine the prevalence of statin use among patients presenting for thoracic aortic aneurysm surgery and investigate its effect on outcomes. Methods From January 1, 2005 to January 1, 2011, 1,839 consecutive patients underwent aortic replacement for degenerative thoracic aortic aneurysm at Cleveland Clinic. Of these, 771 (42%) were on statins preoperatively. Statin users (vs. nonstatin users) were older (65 ± 11 vs. 56 ± 16 years) and had more hypertension (78 vs. 59%). Propensity matching based on 56 preoperative variables other than lipid levels was used to compare outcomes among 570 matched patient pairs (74% of possible pairs). Results Propensity-matched statin and nonstatin users were aged 64 ± 11 years, 394 (69%) versus 387 (68%) were male, and 437 (77%) versus 442 (78%) had ascending aortic aneurysms, respectively. Overall, 25% of patients were followed for more than 8.2 years and 10% for more than 10 years. Perioperative outcomes were similar, including hospital mortality (11 1.9% vs. 5 0.88%) and stroke (22 3.9% vs. 13 2.3%), but 16 statin users (2.8%) versus 5 nonstatin users (0.88%) required temporary dialysis after surgery (p = 0.02). At 6 years, 3.7% of statin users versus 5.1% of nonstatin users (plog-rank = 0.5) underwent further aortic surgery, and at 10 years, mortality was 25% in both groups (p > 0.5). Conclusion Patients presenting for thoracic aortic aneurysm surgery frequently receive unnecessary statins. Additionally, statin use was associated with more postoperative renal failure, but not less intermediate-term risk for aortic reintervention or all-cause mortality after surgery. Therefore, presence of a thoracic aortic aneurysm should not be considered an indication for statin therapy in the absence of well-established indications.
Kindzelski et al. (Sun,) conducted a observational in Degenerative thoracic aortic aneurysm (n=1,839). Preoperative statin therapy vs. No preoperative statin therapy was evaluated on New-onset renal failure requiring dialysis (p=0.02). Preoperative statin use in patients undergoing thoracic aortic aneurysm surgery was associated with a higher rate of postoperative renal failure requiring dialysis (2.8% vs 0.88%, p=0.02).