Abstract
Myocardial injury after noncardiac surgery (MINS) is recently accepted as a strong predictor of mortality, regardless of symptoms. However, anticoagulation is the only established treatment. This study aimed to evaluate the association between statin treatment and mortality after MINS. From January 2010 to June 2019, a total of 5,267 adult patients who were discharged after the occurrence of MINS were enrolled. The patients were divided into two groups according to statin prescription at discharge. The outcomes were 1-year and overall mortalities. Of the total 5,109 patients, 1,331 (26.1%) patients were in the statin group and 3,778 (73.9%) patients were in the no statin group. The 1-year and overall mortalities were significantly lower in the statin group compared with the no statin group (6.1% vs. 13.3%; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.41–0.74; p < 0.001 for 1-year mortality and 15.0% vs. 25.0%; HR, 0.62; 95% CI, 0.51–0.76; p < 0.001 for overall mortality). Analyses after inverse probability treatment weighting showed similar results (HR, 0.61; 95% CI, 0.50–0.74; p < 0.001 for 1-year mortality and HR, 0.70; 95% CI, 0.54–0.90; p = 0.006 for overall mortality), and the mortalities did not differ according to the dose of statin. Our results suggest that statin treatment may be associated with improved survival after MINS. A trial is needed to confirm this finding and establish causality.
Highlights
Myocardial injury after noncardiac surgery (MINS) is recently accepted as a strong predictor of mortality, regardless of symptoms
A total of 5,109 patients was divided into two groups according to statin prescription at discharge: 3,778 (73.9%) patients were in the no statin group and 1,331 (26.1%) patients were in the statin group
We enrolled 5,109 adult patients who were discharged alive after suffering myocardial injury after all types of noncardiac surgery that was performed at our institution during the study period and compared mortalities within 1-year after discharge and overall mortalities during median follow-up period of 711 days (IQR 223–1559)
Summary
Myocardial injury after noncardiac surgery (MINS) is recently accepted as a strong predictor of mortality, regardless of symptoms. The benefit of statin during the perioperative period remains controversial, because some randomized trials failed to demonstrate the primary prevention of postoperative cardiovascular complications including MINS, especially in patients with low cardiac risk[9,10] Instead, another randomized trial showed a protective effect of statin use in patients, limited to those who had atherosclerotic coronary disease and received long-term therapy after surgery[11]. Another randomized trial showed a protective effect of statin use in patients, limited to those who had atherosclerotic coronary disease and received long-term therapy after surgery[11] Based on these previous results, we hypothesized that in patients who were diagnosed with MINS, statin prescription at discharge may improve long-term mortalities
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