Abstract
BackgroundStatins are widely prescribed to patients with atherosclerosis. A retrospective database analysis was used to examine the role of preoperative statin use in hospital mortality, for patients undergoing isolated coronary artery bypass grafting (CABG.)MethodsThe study population comprised 2377 patients who had isolated CABG at Allegheny General Hospital between 2000 and 2004. Mean age of the patients was 65 ± 11 years (range 27 to 92 years). 1594 (67%) were male, 5% had previous open heart procedures, and 4% had emergency surgery. 1004 patients (42%) were being treated with a statin at the time of admission. Univariate, bivariate (Chi2, Fisher's Exact and Student's t-tests) and multivariate (stepwise linear regression) analyses were used to evaluate the association of statin use with mortality following CABG.ResultsAnnual prevalence of preoperative statin use was similar over the study period and averaged 40%. Preoperative clinical risk assessment demonstrated a 2% risk of mortality in both the statin and non-statin groups. Operative mortality was 2.4% for all patients, 1.7% for statin users and 2.8% for non-statin users (p < 0.07). Using multivariate analysis, lack of statin use was found to be an independent predictor of mortality in high-risk patients (n = 245, 12.9% vs. 5.6%, p < 0.05).ConclusionsBetween 2000 and 2004 less than 50% of patients at this institution were receiving statins before admission for isolated CABG. A retrospective analysis of this cohort provides evidence that preoperative statin use is associated with lower operative mortality in high-risk patients.
Highlights
The use of 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors has been shown to reduce death, myocardial infarction and stroke in patients with elevated serum cholesterol and in those with near normal serum cholesterol levels [1]
Evidence has accumulated that statins have beneficial effects on various portions of the clinical pathway that leads to atherosclerosis and cardiovascular events
The use of statins has steadily increased over time, but these drugs remain under utilized, relative to the larger population at risk for atherosclerosis
Summary
The use of 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce death, myocardial infarction and stroke in patients with elevated serum cholesterol and in those with near normal serum cholesterol levels [1]. The mechanism of this improvement is likely multifactorial, with some benefit attributed to lipid lowering effects and some to lipidindependent (pleiotropic) properties. Evidence has accumulated that statins have beneficial effects on various portions of the clinical pathway that leads to atherosclerosis and cardiovascular events. A retrospective database analysis was used to examine the role of preoperative statin use in hospital mortality, for patients undergoing isolated coronary artery bypass grafting (CABG.)
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