Abstract
Background: Coronary artery bypass grafting (CABG) is associated with several perioperative complications that may significantly prolong length of in-hospital stay, increase costs and provide worse long term outcome. The 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitors, or statins, exert anti-inflammatory and vascular protective effects. We hypothesized that pre-operatory statin therapy may reduce incidence of early perioperative complications and length of in-hospital stay following CABG.Methods: We retrospectively enrolled 103 patients (age 67±3; 18 females), who underwent CABG. Patients were allocated into 2 groups: 57 patients on statin therapy prior to CABG (St Group) and 46 patients not on statin therapy (n-St group). Demographic and clinical features, pre-operative medications use and the incidence of early adverse postoperative events were collected. Pre-operative risk of death using the European System for Cardiac Operative Risk Evaluation (EuroSCORE) was also calculated. The primary end-point was the composite of early complications occurring after surgery, including infections, bleedings, sustained ventricular and supra-ventricular tachyarrhythmias, cardiogenic shock, myocardial infarction and mortality. As secondary end-points single perioperative complications were considered. In-hospital stay length was also evaluated.Results: Clinical features, cholesterol levels and EuroSCORE were similar between two groups. Statin therapy and EuroSCORE emerged as predictors of the composite adverse outcome. n-St patients had a significant higher rate of early complications if compared with St patients: the primary endpoint occurred in 18 St patients (31%) versus 25 (54%) non-St patients (p=0.019). Multivariate analysis confirmed pre-operative statin therapy and EuroSCORE as independent predictors of the primary endpoint (OR=0.307, 95% CI=0.123-0.766, p=0.011 and OR= 2.114, 95% CI= 1.213- 4.407, p= 0.002 respectively) showing a protective role of the statin therapy.The incidence of secondary end-points did not differ significantly between the groups, while in-hospital stay was longer in n-St group if compared with St group (7.7±3,9 days vs 5,6±1,8 days; p=0,001).Conclusion: Our data suggest that statin therapy may reduce early perioperative complications after coronary artery bypass grafting. This effect is independent from cholesterol basal levels, thus supporting pre-operative statin use in patients undergoing CABG.
Highlights
Despite the improvements in the surgical technologies, coronary artery bypass grafting (CABG) associated mortality is a considerable medical and socioeconomic problem, with estimates ranging as high as 2% to 4%
No significantly statistical differences were observed between groups with respect to age, gender, presence of diabetes, history of myocardial infarction, smoke habit, hypertension, presence of three-vessel disease, cerebrovascular and pulmonary disease, renal failure, and EuroSCORE
Multivariate analysis confirmed pre-operative statin therapy and EuroSCORE as independent predictors of the primary endpoint (OR=0.307, 95% confidence interval (95% CI)=0.123-0.766, p=0.011 and odds ratio (OR)= 2.114, 95% CI= 1.213- 4.407, p= 0.002 respectively) (Table 2). n-St patients had a significant higher rate of early complications if compared with St patients: the primary endpoint occurred in 18 St patients (31%) versus 25 (54%) non-St patients (p=0,019) (Table 3)
Summary
Despite the improvements in the surgical technologies, coronary artery bypass grafting (CABG) associated mortality is a considerable medical and socioeconomic problem, with estimates ranging as high as 2% to 4%. Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, are powerful inhibitors of cholesterol biosynthesis. Beyond their lipid-lowering actions, statins are known to exert multiple pleiotropic effects including improvement of endothelial function, plaque stabilization, decrease of inflammatory markers, and attenuation of myocardial ischaemia-reperfusion injury that can offer direct organ protection and contribute to improve clinical outcome in the early postoperative course [2,3,4]. Statins were found to be associated with a reduced incidence of perioperative mortality in patients undergoing major non-cardiac vascular surgery [6,7]. Coronary artery bypass grafting (CABG) is associated with several perioperative complications that may significantly prolong length of in-hospital stay, increase costs and provide worse long term outcome.
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