Does Early Graft Patency Benefit from Perioperative Statin Therapy? A Propensity Score-Matched Study of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery.

Shanglin Chen,Hansong Sun,Yuanyu Hu,Hengchao Wu,Baotong Li,Tao Yang

doi:10.1155/2019/1582183

Shanglin Chen, Hansong Sun + Show 4 more

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https://doi.org/10.1155/2019/1582183

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Abstract

Background Decreased graft patency after off-pump coronary artery bypass grafting (OPCAB) leads to substantial increases in cardiac events. However, there is paucity of data on efficacy and safety of perioperative statin therapy for OPCAB populations. Methods 582 patients undergoing OPCAB in a single-institution database (October 1, 2009–September 30, 2012) were stratified by perioperative continuation of statin therapy (CS group, n=398) or not (DS group, n=184). Inverse probability weighted propensity adjustment was used to account for treatment assignment bias, resulting in a well-matched cohort. Primary outcomes were graft patency at an average of five days after operation and in-hospital mortality. Secondary outcomes included intraoperative blood loss, liver, and renal functions. Results No in-hospital death occurred in this study. Early graft patency rates after OPCAB were 98.4% (1255 of 1275 grafts) in the CS group and 98.0% (583 of 595 grafts, P=0.486) in the DS group. Secondary outcomes showed a reduction in blood loss during operation (438.53 mL versus 480.47 mL, P=0.01). Continuation of statin therapy is associated with alanine transaminase (ALT) elevation (49.67 U/L versus 34.52 U/L, P<0.001), as well as aspartate transaminase (33.54 U/L versus 28.10 U/L, P<0.001). Abnormal ALT elevation was observed in 8.9% of the CS group and 3.1% in DS (odds ratio 3.06, 95% confidence interval, 1.77 to 5.29, P<0.001). There was no significant difference in estimated glomerular filtration rate (76.28 mL/min/1.73m2 versus 76.13 mL/min/1.73m2, P=0.90). Subgroup analyses suggested that graft occlusion was less common in CS than in DS group among smoking patients (odds ratio 0.41, 95% confidence interval, 0.20 to 0.86, P=0.026). Conclusions Perioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. A lower risk of graft occlusion was observed among smoking patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT 01268917).

Highlights

In 2017, European Association for Cardiothoracic Surgery (EACTS) guidelines on perioperative medication in adult cardiac surgery suggested that it was not recommended to initiate statin therapy shortly before cardiac surgery [1].Off-pump coronary artery bypass grafting surgery (OPCAB) has offered a promising alternative strategy for revascularization
Propensity-score matched cohort study, our findings showed that the early graft patency did not differ between patients receiving perioperative continuous statin therapy and those receiving discontinuous statin therapy, both before and after Inverse probability weighting (IPW) adjustment
It should be noted that mean low-density lipoprotein (LDL) levels of patients on continuous statin treatment were reduced to 65.35 mg/dL and 65.02 mg/dL, both of which were lower than the target level of aggressive LDL lowering therapy (70 mg/dL), as established by the 2018 AHA/ACC guideline [16]

Summary

Introduction

In 2017, European Association for Cardiothoracic Surgery (EACTS) guidelines on perioperative medication in adult cardiac surgery suggested that it was not recommended to initiate statin therapy shortly before cardiac surgery [1].Off-pump coronary artery bypass grafting surgery (OPCAB) has offered a promising alternative strategy for revascularization. Graft patency is one of the most widely studied areas among these populations because of its significant role in long-term outcomes and quality of life [2,3,4], as OPCAB is technically more demanding than on-pump coronary artery bypass surgery regarding the operative field, target vessels, and learning curve for the procedure [5, 6]. To evaluate the efficacy and safety of perioperative continuation of statin therapy in patients undergoing OPCAB, this retrospective cohort study was conducted to determine the impact of perioperative statin use on early graft patency as well as other in-hospital outcomes. Perioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT 01268917)

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