Early outcomes of perioperative statin therapy for elderly patients undergoing off-pump coronary artery bypass surgery: a propensity score-matched study

Abstract

BackgroundFew studies have investigated the efficacy and safety of perioperative continuation of statin therapy in individuals who undergo off-pump coronary artery bypass surgery (OPCAB). This study aims to evaluate the efficacy of perioperative continuation of statin therapy on early graft patency and clinical outcomes among elderly patients who underwent OPCAB. MethodsA total of 330 consecutive elderly patients (age >60 years) who underwent OPCAB in a single-institution database (Oct 1, 2009, to Sept 30, 2012) were stratified by perioperative continuation of statin administration. To account for baseline differences, patients were propensity matched by inverse probability weighting across 20 preoperative and procedural characteristics, resulting in a well matched cohort. The primary outcomes were perioperative graft patency at an average of 5 days after operation, as assessed by independent blinded observers documented by multislice CT angiography, and in-hospital mortality. Secondary outcomes included duration of stay in the intensive care unit, blood biomarkers, left ventricular function, and liver and renal function. All statistical analyses were performed using SAS for Windows version 9.1. FindingsThere was no in-hospital death in this study. LDL concentration was significantly lower in those who continued statin therapy than in those who discontinued (64·24 mg/dL vs 77·05 mg/dL, p<0·0001). Total cholesterol concentration was also lower within the continued statin group (126·47 mg/dL vs 138·14 mg/dL, p<0·0001). Perioperative graft patency did not differ significantly between the continued statin group (237 patients, 98%) and the discontinued statin group (93 patients, 97%; p=0·6). Secondary outcomes showed no significant difference in serum creatinine (1·08 mg/dL vs 1·09 mg/dL, p=0·9) and estimated glomerular filtration rate (69·19 mL/min per 1·73m2vs 69·63 mL/min per 1·73m2, p=0·8). However, abnormal elevation of alanine transaminase was observed in 237 (8%) patients within the continued statin group and in 93 (2%) patients within the discontinued statin group (p=0·001). InterpretationAmong elderly patients undergoing OPCAB, the continued administration of perioperative statin therapy did not improve early graft patency. Perioperative continuation of statin use tended to increase the risk of abnormal liver function. There is insufficient evidence to recommend perioperative continuation of statin therapy for OPCAB. FundingNo funding.