Thielmann Matthias, Neuhäuser Markus, Marr Anja, Jaeger Beate R, Wendt Daniel, Schuetze Bernd, Kamler Markus, Massoudy Parwis, Erbel Raimund, Jakob Heinz
Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
J Thorac Cardiovasc Surg. 2007 Nov;134(5):1143-9. doi: 10.1016/j.jtcvs.2007.07.029.
Statins are powerful lipid-lowering drugs that have been proved effective in the prevention of coronary artery disease, clearly reducing the risk of mortality and cardiovascular events. Whether hyperlipidemic patients undergoing coronary artery bypass grafting profit from the lipid-lowering beneficial effects of statins is as yet uncertain. We sought to determine whether preoperative statin therapy may have an effect on outcome among hyperlipidemic patients undergoing coronary artery bypass grafting.
From January 2000 through March 2006, prospectively recorded clinical data from 3346 consecutive patients undergoing isolated first-time elective coronary artery bypass grafting were analyzed for major adverse cardiac events and all-cause in-hospital mortality. Of these, 167 patients had preoperative statin-untreated hyperlipidemia (group 1), 2592 had statin-treated hyperlipidemia (group 2), and 587 had statin-untreated normolipidemia (group 3).
Risk-adjusted multivariate logistic regression analysis revealed statin-treated hyperlipidemia (odds ratio, 0.42; 95% confidence interval, 0.26-0.69; P = .0007) and statin-untreated normolipidemia (odds ratio, 0.42; confidence interval, 0.26-0.69; P = .0007) to be independently associated with reduced in-hospital major adverse cardiac events but not with in-hospital mortality. To further control for selection bias, a computed propensity score matching based on 14 major preoperative risk factors was performed. After propensity matching, conditional logistic regression analysis confirmed statin-treated hyperlipidemia and statin-untreated normolipidemia to be strongly related to reduced in-hospital major adverse cardiac events (odds ratio, 0.41; 95% confidence interval, 0.24-0.71 [P = .0013] and odds ratio, 0.23; 95% confidence interval, 0.11-0.48 [P = .0001]) but not with in-hospital mortality (odds ratio, 1.18; 95% confidence interval, 0.36-3.87 [P = .79] and odds ratio, 1.10; 95% confidence interval, 0.32-4.41 [P = .80]) after coronary artery bypass grafting surgery.
Hyperlipidemic, but not normolipidemic, patients have an increased risk for in-hospital major adverse cardiac events and therefore clearly benefit from preoperative statin therapy before coronary artery bypass grafting surgery.
他汀类药物是强效降脂药，已被证明在预防冠状动脉疾病方面有效，能显著降低死亡率和心血管事件风险。接受冠状动脉搭桥术的高脂血症患者是否能从他汀类药物的降脂有益作用中获益尚不确定。我们试图确定术前他汀类药物治疗是否会对接受冠状动脉搭桥术的高脂血症患者的预后产生影响。
对2000年1月至2006年3月期间连续3346例接受首次择期孤立冠状动脉搭桥术患者的前瞻性记录临床数据进行分析，以评估主要不良心脏事件和院内全因死亡率。其中，167例患者术前有未接受他汀类药物治疗的高脂血症（第1组），2592例患者有接受他汀类药物治疗的高脂血症（第2组），587例患者有未接受他汀类药物治疗的正常血脂（第3组）。
风险调整后的多因素逻辑回归分析显示，接受他汀类药物治疗的高脂血症（比值比，0.42；95%置信区间，0.26 - 0.69；P = 0.0007）和未接受他汀类药物治疗的正常血脂（比值比，0.42；置信区间，0.26 - 0.69；P = 0.0007）与院内主要不良心脏事件减少独立相关，但与院内死亡率无关。为进一步控制选择偏倚，基于14个主要术前危险因素进行了计算倾向评分匹配。倾向匹配后，条件逻辑回归分析证实，接受他汀类药物治疗的高脂血症和未接受他汀类药物治疗的正常血脂与院内主要不良心脏事件减少密切相关（比值比，0.41；95%置信区间，0.24 - 0.71 [P = 0.0013]和比值比，0.23；95%置信区间，0.11 - 0.48 [P = 0.0001]），但与冠状动脉搭桥术后的院内死亡率无关（比值比，1.18；95%置信区间，0.36 - 3.87 [P = 0.79]和比值比，1.10；95%置信区间，0.32 - 4.41 [P = 0.80]）。
高脂血症患者而非正常血脂患者发生院内主要不良心脏事件的风险增加，因此在冠状动脉搭桥术前接受术前他汀类药物治疗明显有益。
