Key result
Perioperative statins significantly reduced the composite of death, myocardial infarction, or stroke in patients undergoing noncardiac surgery (OR 0.617; 95% CI 0.476-0.801; p=0).
Why the study?
Does perioperative statin treatment reduce cardiovascular complications in patients undergoing noncardiac surgery?
Meta-Analysis (n=4,707)
Does perioperative statin treatment reduce cardiovascular complications in patients undergoing noncardiac surgery?
Odds Ratio: 0.617 (95% CI 0.476–0.801)
p-value: p=0
Perioperative statin use in noncardiac surgery significantly reduces the risk of postoperative myocardial infarction, new-onset atrial fibrillation, and the composite of death, MI, or stroke.
Supports perioperative statin consideration in noncardiac surgery; reinforces meta-analytic evidence for major cardiovascular event reduction.
BACKGROUND: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes. OBJECTIVE: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery. METHODS: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes. RESULTS: Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR) = 0.460, 95% confidence interval (CI) = 0.324-0.653, p = 0 for myocardial infarction; OR = 0.617, 95% CI = 0.476-0.801, p = 0 for composite of death/myocardial infarction/stroke; OR = 0.406, 95% CI = 0.247-0.666, p = 0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms. CONCLUSIONS: This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery. Key Messages Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.
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Ma et al. (2018) conducted a meta-analysis in noncardiac surgery (n=4,707). perioperative statins vs. control treatment was evaluated on composite of death/myocardial infarction/stroke (OR 0.617, 95% CI 0.476-0.801, p=0). Perioperative statins significantly reduced the composite of death, myocardial infarction, or stroke in patients undergoing noncardiac surgery (OR 0.617; 95% CI 0.476-0.801; p=0).
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