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mardi 18 août 2015

Statins work for severe atheromatous patients who underwent CABG

Figure 2:
Figure 2:
Forrest plots of pooled treatment effect estimates of analysed clinical outcomes from all included trials (n = 54). AF: atrial fibrillation; OR: odds ratio; CI: confidence interval.

"Importantly, the findings of the presented meta-analysis must be weighed against the clinical relevance for the individual patient. Whereas the described reductions of the length of stay on the ICU or in the hospital predominantly have more economic rather than clinical implications for the individual patient, it needs to be stressed that one death seems to be avoided in 118 patients with a statin pretreatment before surgery—a low-cost therapy that is well tolerated by most patients. Furthermore, the beneficial effect on the incidence of stroke and atrial fibrillation definitely is clinically relevant due to associated consequences for the patient in addition to the extensive additional health care costs."

"Although this work represents an updated version of the recently published meta-analysis of Liakopoulos et al. with a 3-fold increased patient population, the findings of the present review are still limited by the low number of available RCTs assessing statin effects on postoperative adverse events in patients undergoing cardiac surgery. It is noteworthy, that of all 54 included studies only 12 trials were RCTs with a negligible impact on the overall result with about 1000 patients. "

Look at this RCT

Preoperative cardiovascular medication and postoperative
mortality from coronary artery bypass graft surgery
Sanders R.1, Venkatesan S.2, Okoli G.2, Myles P. 2
1Universit y of Wisconsin, Dept of Anaesthesiology, Madison, United States,
2Universit y of Not tingham, Public Health, Nottingham, United Kingdom
Background and Goals of Study: Preoperative cardiovascular medication
can influence perioperative risk. Statins reduce perioperative risk from coronary
bypass graf t (CABG) surgery1 however the influence of other medication
including angiotensin converting enzyme inhibitors, calcium channel antagonists,
alpha2 adrenergic agonists and beta blockers is less clear2-4. Herein we
evaluated the influence of each of these medications on perioperative risk and
the long term and class protective ef fect of statins.
Materials and Methods: United Kingdom Clinical Practice Research Datalink
data from 16,192 patients aged 40 years or older that underwent CABG surgery
were obtained. Five multivariable logistic regression models, including
propensity scores and further Cox Regression analysis, were employed to
probe the robustness of the ef fect on perioperative mortality.
Results and Discussion: Exposure to statins was most prevalent (85.1% of
patients), followed by beta-blockers (72.8%), ACE inhibitors (60.5%), calcium
channel blockers (42.8%) and alpha-2 agonists (1.2%). Statins were associated
with a statistically significant protective ef fect against perioperative mortality
in all five logistic regression models with adjusted ORs (95% CI) ranging
from 0.26 (0.13 to 0.54) to 0.35 (0.18 to 0.67). Cox regression for perioperative
mortality [adjusted HR (95% CI): 0.40 (0.20 to 0.80)] and six-month mortality
[HR (95% CI): 0.63 (0.42 to 0.92)] produced similar results. Of the statins
tested, only simvastatin exerted protective ef fects (adjusted OR 0.33 (0.14 -
0.78). Consistent ef fects on perioperative mortality, for the other medications,
were not observed.
Conclusions: Statins exerted a significant protective ef fect on perioperative
mortality from CABG surgery that was not shared by the other cardiovascular
medications. Further data are needed on whether all statins exert similar effects.
[Figure 1]

1. Kuhn Eur J Cardiothorac Surg. 2014;45:17-26.
2. Wijeysundera JACC 2003;41:1496-1505.
3. Yacoub Am J Kidney Dis. 2013;62:1077-1086.
4. Brinkman et al. JAMA Intern Med. 2014;174:1320-132.

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