Reitze Rodseth, MD; P.J. Devereaux, MD, PhD
Does perioperative statin treatment improve clinical outcomes in adults having surgery and not using long-term statins?
Included studies evaluated perioperative statin treatment in patients ≥ 18 years of age who were having surgery and were not maintained on long-term statin treatment before surgery (statin-naïve). Exclusion criteria included percutaneous coronary interventions and cardioversions. Studies had to report ≥ 1 of the following outcomes: perioperative death, myocardial infarction (MI), atrial fibrillation (AF), length of hospital stay, or length of intensive care unit (ICU) stay.
MEDLINE, EMBASE/Excerpta Medica, Biosis, Cochrane Central Register of Controlled Trials, Conference Proceedings Index, Web sites (ClinicalTrials.gov, International Federation of Pharmaceutical Manufacturers, and Pharmaceutical Research and Manufacturers of America), and reference lists were searched to April 2011 for published and unpublished randomized controlled trials (RCTs). Experts and study authors were contacted. 15 RCTs (n = 2292, 59% to 90% men) met inclusion criteria. Studies enrolled patients having cardiac surgery (11 RCTs, n = 1056), noncardiac surgery (2 RCTs, n = 1030), and vascular surgery (2 RCTs, n = 206). 14 studies used a placebo control, and 1 study compared high-dose with low-dose atorvastatin. Statins assessed were atorvastatin (8 RCTs, n = 852), fluvastatin (3 RCTS, n = 1076), simvastatin (2 RCTs, n = 121), rosuvastatin (1 RCT, n = 200), and pravastatin (1 RCT, n = 43). 7 studies were at low-risk for bias (Cochrane Statistical Methods Group criteria).
Compared with controls, perioperative statins reduced risk for MI in patients having any surgery and AF in patients having cardiac surgery; groups did not differ for mortality in patients having any surgery (Table). Perioperative statins reduced length of hospital stay, but not length of ICU stay, more than controls (Table).
Perioperative statins reduce risk for myocardial infarction and atrial fibrillation in statin-naïve patients.
Perioperative statins vs control in statin-naïve patients having surgery*
*AF = atrial fibrillation; ICU = intensive care unit; MI = myocardial infarction; SMD = standardized mean difference; other abbreviations defined in Glossary. Weighted event rates, RRRs, NNTs, and CIs calculated from relative risks and control event rates reported in article using a random-effects model.
†5 additional studies reported no deaths.
‡All studies done in patients having cardiac surgery.
§Negative values indicate benefit with statin treatment.
||Heterogeneity between studies, I2 = 79%, P≤ 0.001
Rodseth R, Devereaux P. Review: Perioperative statins reduce perioperative MI and AF in statin-naïve patients. Ann Intern Med. ;156:JC6–2. doi: 10.7326/0003-4819-156-12-201206190-02002
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Published: Ann Intern Med. 2012;156(12):JC6-2.
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