Le Manach Yannick, Godet Gilles, Coriat Pierre, Martinon Claire, Bertrand Michèle, Fléron Marie-Hélène, Riou Bruno
Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France.
Anesth Analg. 2007 Jun;104(6):1326-33, table of contents. doi: 10.1213/01.ane.0000263029.72643.10.
Statins reduce cardiac morbidity in nonsurgical populations, and may benefit surgical patients. We sought to examine cardiac outcome in patients who continued, compared with those who discontinued, statin therapy after major vascular surgery.
Prospectively collected data were examined for an association between statin therapy and perioperative cardiac morbidity in patients undergoing infrarenal aortic surgery. Between January 2001 and December 2003, there were no guidelines for perioperative continuation of statins (discontinuation group, n = 491). From January 2004, guidelines were instituted whereby statin therapy was continued starting as soon as possible after surgery (continuation group, n = 178). The occurrence of cardiac myonecrosis (defined as an increase of cardiac troponin I more than the 99th percentile or 0.2 ng/mL) was analyzed. Intra-cohort (propensity score) and extra-cohort (Lee score) adjustments of the risk were performed.
The median delay between surgery and resumption of statin therapy was 4 days and 1 day in the discontinuation and continuation groups (P < 0.001), respectively. Using propensity score matching for likelihood of preoperative treatment, the odds ratio associated with chronic statin treatment to predict myonecrosis for patients with versus without early postoperative statin resumption (continuation versus discontinuation groups) was 0.38 and 2.1 (relative risk reduction of 5.4; 95% confidence interval: 1.2-25.3, P < 0.001), respectively. The odds ratio after adjustment for the Lee score was 0.38 in the continuation group and 2.1 in the discontinuation group (relative reduction of 5.5; 95% confidence interval: 1.2-26.0, P < 0.001). Postoperative statin withdrawal (>4 days) was an independent predictor of postoperative myonecrosis (OR 2.9, 95% confidence interval 1.6-5.5).
Discontinuation of statin therapy after major vascular surgery is associated with an increased postoperative cardiac risk, suggesting that statin therapy should be resumed early after major vascular surgery.
他汀类药物可降低非手术人群的心脏发病率，可能对手术患者有益。我们试图比较大血管手术后继续使用他汀类药物治疗的患者与停用该药物治疗的患者的心脏结局。
前瞻性收集接受肾下主动脉手术患者的数据，以研究他汀类药物治疗与围手术期心脏发病率之间的关联。2001年1月至2003年12月期间，尚无围手术期继续使用他汀类药物的指南（停药组，n = 491）。从2004年1月起，制定了指南，术后尽快继续使用他汀类药物治疗（继续用药组，n = 178）。分析心肌坏死的发生情况（定义为心肌肌钙蛋白I升高超过第99百分位数或0.2 ng/mL）。对风险进行了队列内（倾向评分）和队列外（Lee评分）调整。
停药组和继续用药组手术至恢复他汀类药物治疗的中位延迟时间分别为4天和1天（P < 0.001）。采用倾向评分匹配法评估术前治疗的可能性，对于术后早期恢复或未恢复他汀类药物治疗的患者（继续用药组与停药组），预测心肌坏死的慢性他汀类药物治疗的比值比分别为0.38和2.1（相对风险降低5.4；95%置信区间：1.2 - 25.3，P < 0.001）。调整Lee评分后的比值比，继续用药组为0.38，停药组为2.1（相对降低5.5；95%置信区间：1.2 - 26.0，P < 0.001）。术后停用他汀类药物（>4天）是术后心肌坏死的独立预测因素（OR 2.9，95%置信区间1.6 - 5.5）。
大血管手术后停用他汀类药物治疗与术后心脏风险增加相关，提示大血管手术后应尽早恢复他汀类药物治疗。
