Pan Wei, Pintar Tatjana, Anton James, Lee Vei-Vei, Vaughn William K, Collard Charles D
Division of Cardiovascular Anesthesiology, Texas Heart Institute, St. Luke's Episcopal Hospital,Houston, Tex 77030, USA.
Circulation. 2004 Sep 14;110(11 Suppl 1):II45-9. doi: 10.1161/01.CIR.0000138316.24048.08.
Statin therapy in nonsurgical patient populations is associated with a significant reduction in adverse cardiovascular events, including death, myocardial infarction (MI), and stroke. Recently, statin therapy was shown to be associated with a reduced incidence of postoperative mortality in patients undergoing major noncardiac vascular surgery. We investigated the influence of preoperative statin therapy on adverse outcomes after primary coronary artery bypass graft (CABG) surgery.
A retrospective cohort study of patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (n=1663) between January 1, 2000 and December 31, 2001 at the Texas Heart Institute was performed. Patients were classified into 2 groups: patients receiving preoperative statin therapy (n=943) and patients not receiving preoperative antihyperlipidemic therapy (n=720). To determine if preoperative statin therapy was independently associated with a reduction in the risk of adverse postoperative outcomes, multivariate stepwise logistic regression was performed controlling for patient demographics, medical history, and preoperative medications. Multivariate logistic regression analysis demonstrated that preoperative statin therapy was independently associated with a significant reduction ( approximately 50%) in the risk of 30-day all-cause mortality (3.75% versus 1.80%; P<0.05). The adjusted odds ratio for early mortality in patients receiving preoperative statin therapy compared with patients not receiving antihyperlipidemic agents was 0.53 (95% CI, 0.28 to 0.99). Statin therapy was not independently associated with a reduced risk of postoperative MI, cardiac arrhythmias, stroke, or renal dysfunction. In an attempt to further control for selection bias related to the choice of therapy, multivariate analysis of a propensity-matched cohort of 1362 patients revealed that preoperative statin therapy was independently associated with a significant reduction in the composite endpoint of 30-day all-cause mortality and stroke (7.1% versus 4.6%; P<0.05).
Preoperative statin therapy may reduce the risk of early mortality after primary CABG surgery with CPB.
在非手术患者群体中，他汀类药物治疗与包括死亡、心肌梗死（MI）和中风在内的不良心血管事件显著减少相关。最近，他汀类药物治疗被证明与接受重大非心脏血管手术患者的术后死亡率降低有关。我们研究了术前他汀类药物治疗对初次冠状动脉旁路移植术（CABG）后不良结局的影响。
对2000年1月1日至2001年12月31日在德克萨斯心脏研究所接受初次体外循环（CPB）下CABG手术的患者（n = 1663）进行了一项回顾性队列研究。患者分为两组：接受术前他汀类药物治疗的患者（n = 943）和未接受术前抗高脂血症治疗的患者（n = 720）。为了确定术前他汀类药物治疗是否与术后不良结局风险降低独立相关，进行了多因素逐步逻辑回归分析，控制患者人口统计学、病史和术前用药情况。多因素逻辑回归分析表明，术前他汀类药物治疗与30天全因死亡率风险显著降低（约50%）独立相关（3.75%对1.80%；P<0.05）。与未接受抗高脂血症药物治疗的患者相比，接受术前他汀类药物治疗患者早期死亡的调整后优势比为0.53（95%CI，0.28至0.99）。他汀类药物治疗与术后MI、心律失常、中风或肾功能不全风险降低无独立相关性。为了进一步控制与治疗选择相关的选择偏倚，对1362例倾向匹配队列患者进行多因素分析显示，术前他汀类药物治疗与30天全因死亡率和中风的复合终点显著降低独立相关（7.1%对4.6%；P<0.05）。
术前他汀类药物治疗可能降低初次CPB下CABG手术后的早期死亡风险。
