Preoperative statin therapy in cardiac surgery patients significantly reduced early all-cause mortality compared to no statin therapy (OR 0.57; 95% CI 0.49-0.67; P<0.0001).
Meta-Analysis (n=31,725)
Does preoperative statin therapy reduce early all-cause mortality and adverse postoperative outcomes in patients undergoing cardiac surgery?
Preoperative statin therapy in cardiac surgery patients is associated with significant reductions in 30-day mortality, atrial fibrillation, and stroke.
Effect estimate: OR 0.57 (95% CI 0.49-0.67)
Absolute Event Rate: 2.2% vs 3.7%
p-value: p=< 0.0001
AIMS: To determine the strength of evidence for preoperative statin use for prevention of adverse postoperative outcomes in patients undergoing cardiac surgery. METHODS AND RESULTS: After literature search in major databases, 19 studies were identified three RCT (randomized prospective clinical trials), 16 observational that reported outcomes of 31 725 cardiac surgery patients with (n = 17 201; 54%) or without (n = 14 524; 46%) preoperative statin therapy. Outcomes that were analysed included early all-cause mortality (30-day mortality), myocardial infarction (MI), atrial fibrillation (AF), stroke and renal failure. Odds ratio (OR) with 95% confidence intervals (95%CI) were reported using fixed or random effect models and publication bias was assessed. Preoperative statin therapy resulted in a 1.5% absolute risk reduction (2.2 vs. 3.7%; P < 0.0001) and 43% odds reduction for early all-cause mortality (OR 0.57; 95%CI: 0.49-0.67). A significant reduction (P < 0.01) in statin pretreated patients was also observed for AF (24.9 vs. 29.3%; OR 0.67, 95%CI: 0.51-0.88), stroke (2.1 vs. 2.9%, OR 0.74, 95%CI: 0.60-0.91), but not for MI (OR 1.11; 95%CI: 0.93-1.33) or renal failure (OR 0.78, 95%CI: 0.46-1.31). Funnel plot and Egger's regression analysis (P = 0.60) excluded relevant publication bias. CONCLUSION: Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials.
Liakopoulos et al. (2008) conducted a meta-analysis in Cardiac surgery (n=31,725). Preoperative statin therapy vs. No preoperative statin therapy was evaluated on Early all-cause mortality (30-day mortality) (OR 0.57, 95% CI 0.49-0.67, p=< 0.0001). Preoperative statin therapy in cardiac surgery patients significantly reduced early all-cause mortality compared to no statin therapy (OR 0.57; 95% CI 0.49-0.67; P<0.0001).