Invited Commentary

Abstract

Mariscalco and colleagues [1Mariscalco G. Cottini M. Zanobini M. et al.Preoperative statin therapy is not associated with a decrease in the incidence of delirium after cardiac operations.Ann Thorac Surg. 2012; 93: 1439-1448Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar] studied statin therapy for the prevention of delirium after cardiac procedures in a large prospective controlled study that used propensity scoring for the likelihood of receiving preoperative statins to match the treatment and control groups. No benefit from statin therapy was apparent. The study appeared adequately powered even though the incidence of delirium in the total study population was lower than predicted. In particular, there was no trend toward benefit from statins that might have become significant in a larger study. In the context of the nonrandomized design it should be noted that several important mechanisms of direct injury to the brain during cardiopulmonary bypass (including hypoperfusion and embolism) were not measured or controlled for in this study, a point that the authors appropriately acknowledge in the study limitations.Delirium remains a troublesome complication after cardiac procedures. It is distressing for patients and their relatives and complicates postoperative care. Its occurrence is also associated with other adverse postoperative outcomes (including death), although whether preventing delirium per se would also reduce these associated complications (as the authors of this study imply) remains uncertain. Nevertheless, pursuit of a strategy to reduce the incidence of both delirium and the related problem of postoperative cognitive dysfunction remains a worthy goal. Unfortunately the evidence is mounting that statins are ineffective in this regard.Mariscalco and colleagues are among a large group of researchers worldwide who have investigated pharmacologic neuroprotection in cardiac procedures only to find inconsistent or negative results. This general line of investigation should, however, continue to be encouraged. The ongoing absence of editorial bias against publishing well-conducted negative studies in The Annals of Thoracic Surgery is an important contribution to clarity about the issue and to a research effort that may one day “strike gold.” Mariscalco and colleagues [1Mariscalco G. Cottini M. Zanobini M. et al.Preoperative statin therapy is not associated with a decrease in the incidence of delirium after cardiac operations.Ann Thorac Surg. 2012; 93: 1439-1448Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar] studied statin therapy for the prevention of delirium after cardiac procedures in a large prospective controlled study that used propensity scoring for the likelihood of receiving preoperative statins to match the treatment and control groups. No benefit from statin therapy was apparent. The study appeared adequately powered even though the incidence of delirium in the total study population was lower than predicted. In particular, there was no trend toward benefit from statins that might have become significant in a larger study. In the context of the nonrandomized design it should be noted that several important mechanisms of direct injury to the brain during cardiopulmonary bypass (including hypoperfusion and embolism) were not measured or controlled for in this study, a point that the authors appropriately acknowledge in the study limitations. Delirium remains a troublesome complication after cardiac procedures. It is distressing for patients and their relatives and complicates postoperative care. Its occurrence is also associated with other adverse postoperative outcomes (including death), although whether preventing delirium per se would also reduce these associated complications (as the authors of this study imply) remains uncertain. Nevertheless, pursuit of a strategy to reduce the incidence of both delirium and the related problem of postoperative cognitive dysfunction remains a worthy goal. Unfortunately the evidence is mounting that statins are ineffective in this regard. Mariscalco and colleagues are among a large group of researchers worldwide who have investigated pharmacologic neuroprotection in cardiac procedures only to find inconsistent or negative results. This general line of investigation should, however, continue to be encouraged. The ongoing absence of editorial bias against publishing well-conducted negative studies in The Annals of Thoracic Surgery is an important contribution to clarity about the issue and to a research effort that may one day “strike gold.” Preoperative Statin Therapy Is Not Associated With a Decrease in the Incidence of Delirium After Cardiac OperationsThe Annals of Thoracic SurgeryVol. 93Issue 5PreviewDelirium after cardiac operations is associated with significant morbidity and death. Statins have been recently suggested to exert protective cerebral effects. This study investigated whether preoperative statins were associated with decreased incidence of postoperative delirium in patients undergoing coronary artery bypass grafting. Full-Text PDF