他汀类药物可降低接受非心脏血管手术患者的围手术期心脏并发症：手术风险降低他汀类药物（StaRRS）研究。

Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study.

作者信息

O'Neil-Callahan Kristin, Katsimaglis George, Tepper Micah R, Ryan Jason, Mosby Carla, Ioannidis John P A, Danias Peter G

机构信息

Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.

出版信息

J Am Coll Cardiol. 2005 Feb 1;45(3):336-42. doi: 10.1016/j.jacc.2004.10.048.

DOI:10.1016/j.jacc.2004.10.048

PMID:15680709

Abstract

OBJECTIVES

We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery.

BACKGROUND

Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter.

METHODS

A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect.

RESULTS

Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p = 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p = 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins.

CONCLUSIONS

Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.

摘要

目的

我们旨在评估他汀类药物是否可降低接受非心脏血管手术患者的心脏并发症。

背景

心血管并发症在接受非心脏手术的患者中导致相当高的发病率。他汀类药物可降低冠心病患者的心脏发病率和死亡率，且在冠状动脉直径出现任何可测量的增加之前就能早期观察到有益的治疗效果。

方法

一项回顾性研究记录了在一家三级转诊中心两年期间（1999年1月至2000年12月）接受颈动脉内膜切除术、主动脉手术或下肢血管重建术的所有患者的特征、既往病史和入院用药情况。记录的围手术期并发症结局包括在本次住院期间发生的死亡、心肌梗死、缺血、充血性心力衰竭和室性快速心律失常。单因素和多因素逻辑回归确定了围手术期心脏并发症的预测因素以及可能具有保护作用的药物。

结果

在1163例符合条件的住院患者中，157例发生了并发症，接受他汀类药物治疗的患者并发症发生率（9.9%）显著低于未接受他汀类药物治疗的患者（16.5%，p = 0.001）。差异主要由心肌缺血和充血性心力衰竭导致。在对围手术期并发症的其他重要预测因素（年龄、性别、手术类型、急诊手术、左心室功能障碍和糖尿病）进行调整后，他汀类药物仍具有高度显著的保护作用（比值比0.52，p = 0.001）。在不同的患者亚组中，保护作用相似，并且在考虑患者使用他汀类药物的倾向以计算其患高胆固醇血症的可能性后，该保护作用仍然存在。