Review
Meta-Analysis of Patients Taking Statins Before Revascularization and Aortic Valve Surgery

Presented at the Poster Session of the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.04.096Get rights and content

Statin intake before cardiac surgery is associated with favorable outcomes. We sought to analyze the evidence for statin pretreatment before isolated coronary artery bypass graft surgery and aortic valve replacement surgery. In this meta-analysis, we demonstrate beneficial results for the endpoints mortality, stroke, atrial fibrillation, and length of stay in hospital in 36,053 statin-pretreated coronary artery bypass graft surgery patients compared with control subjects retrieved from 32 studies, but fail to detect relevant advantages through preoperative statin therapy for 3,091 patients undergoing aortic valve replacement from four trials. Strict adherence to guidelines recommending statin treatment before CABG surgery is therefore mandatory.

Section snippets

Study Selection Criteria

Randomized clinical trials (RCTs) and retrospective studies (published from 1966 to 2011) were searched that assessed clinical outcomes in patients with statin intake compared with patients without statin therapy before isolated CABG surgery or isolated AVR. Studies were included without restrictions to kind of statin used, duration of statin intake, or dose. Outcomes of interest were all-cause postoperative short-term mortality, myocardial infarction (MI), stroke, postoperative atrial

Selection and Characteristics of Included Studies

Figure 1 summarizes the literature search. Using the predefined search algorithm, a total of 2,371 abstracts were retrieved for initial screening, of which 2,296 abstracts were excluded. Finally, 36 studies were included in the meta-analysis after detailed assessment and further exclusion of 39 trials for reasons depicted in Figure 1. Thirty-two studies assessed statin treatment versus control in isolated CABG surgery with a cumulative cohort of 36,053 patients 14, 15, 16, 17, 18, 19, 20, 21, 22

Comment

This presented literature review with meta-analysis sought to assess the current evidence for preoperative statin therapy before isolated CABG surgery or isolated AVR. In the cohort undergoing isolated CABG procedures, a total of 36,053 patients retrieved from 32 trials was included in the final analysis. Significant reductions in the odds for the endpoints short-term mortality, stroke, and AF were associated with statin treatment compared with control therapy with a reduced length of stay in

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    ∗

    Drs Kuhn and Liakopoulos contributed equally to this review.

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    Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.