Abstract
IntroductionInduction of an inflammatory response is thought to have a significant role in the complications that follow cardiopulmonary bypass (CPB). The statin drugs are increasingly being recognized as having potent anti-inflammatory effects and hence have potential to influence an important mechanism of injury in CPB, although there is no current confirmation that this is indeed the case. Our objective was to systematically review if pre-operative prophylactic statin therapy, compared with placebo or standard of care, can decrease the inflammatory response in people undergoing heart surgery with CPB.MethodsWe performed a systematic and comprehensive literature search for all randomized controlled trials (RCTs) of open heart surgery with CPB in adults or children who received prophylactic statin treatment prior to CPB, with reported outcomes which included markers of inflammation. Two authors independently identified eligible studies, extracted data, and assessed study quality using standardized instruments. Weighted mean difference (WMD) was the primary summary statistic with data pooled using a random effects model. Descriptive analysis was used when data could not be pooled.ResultsEight RCTs were included in the review, with the number of trials for each inflammatory outcome being even more limited. Pooled data demonstrated benefit with the use of statin to attenuate the post-CPB increase in interleukins 6 and 8 (IL-6, IL-8), peak high sensitivity C-reactive protein (hsCRP), and tumor necrosis factor-alpha (TNF-α) post-CPB (WMD [95% confidence interval (CI)] -23.5 pg/ml [-36.6 to -10.5]; -23.4 pg/ml [-35.8 to -11.0]; -15.3 mg/L [CI -26.9 to -3.7]; -2.10 pg/ml [-3.83 to -0.37] respectively). Very limited RCT evidence suggests that prophylactic statin therapy may also decrease adhesion molecules following CPB including neutrophil CD11b and soluble P (sP)-selectin.ConclusionsAlthough the RCT evidence may suggest a reduction in post-CPB inflammation by statin therapy, the evidence is not definitive due to significant limitations. Several of the trials were not methodologically rigorous and statin intervention was highly variable in this small number of studies. This systematic review demonstrates that there is a significant gap that exists in the current literature in regards to the potential anti-inflammatory effect of statin therapy prior to CPB.
Highlights
Induction of an inflammatory response is thought to have a significant role in the complications that follow cardiopulmonary bypass (CPB)
Very limited randomized controlled trials (RCTs) evidence suggests that prophylactic statin therapy may decrease adhesion molecules following CPB including neutrophil CD11b and soluble P-selectin
Conclusions the RCT evidence may suggest a reduction in post-CPB inflammation by statin therapy, the evidence is not definitive due to significant limitations
Summary
Induction of an inflammatory response is thought to have a significant role in the complications that follow cardiopulmonary bypass (CPB). Our objective was to systematically review if pre-operative prophylactic statin therapy, compared with placebo or standard of care, can decrease the inflammatory response in people undergoing heart surgery with CPB. The use of cardiopulmonary bypass (CPB) is necessary for many cardiac surgical procedures. Economic costs and the human costs are greater when cardiac surgical patients develop complications following CPB [1,2]. The development and use CABG: coronary artery bypass graft; CENTRAL: The Cochrane Central Register of Controlled Trials; CI: confidence interval; CPB: cardiopulmonary bypass; hsCRP: high sensitivity C-reactive protein; ICAM-1: intercellular adhesion molecule-1; IL: interleukin; NNT: number needed to treat; RCT: randomized controlled trials; RD: risk difference; RR: risk ratio; sP-selectin: soluble P-selectin; TNF-α: tumor necrosis factor-alpha; WMD: weighted mean difference
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