Virani Salim S, Nambi Vijay, Lee Vei-Vei, Elayda MacArthur, Reul Ross M, Wilson James M, Ballantyne Christie M
Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Am J Cardiol. 2008 Nov 1;102(9):1235-9. doi: 10.1016/j.amjcard.2008.06.055. Epub 2008 Aug 27.
Preoperative statins have been associated with decreased mortality after coronary artery bypass grafting. Data are limited on whether these benefits extend to patients undergoing cardiac valve surgery. We examined whether preoperative statins decrease morbidity and mortality in patients undergoing isolated cardiac valve surgery. In a retrospective cohort analysis of consecutive patients who underwent surgical valve repair or replacement (excluding concomitant coronary artery bypass grafting, aortic root replacement, or ventricular assist device placement) at St. Luke's Episcopal Hospital, the primary outcome was 30-day mortality. Secondary outcomes included 30-day major adverse events (composite of early mortality, postoperative myocardial infarction, or stroke). Of 825 patients, 31% received preoperative statins (n = 255). Logistic regression analysis revealed that age >65 years (p = 0.02), history of congestive heart failure (p = 0.001), and total bypass time >80 minutes (p = 0.01) were independent predictors of increased 30-day mortality. Preoperative statin therapy was not associated with decreased 30-day mortality (odds ratio 0.89, 95% confidence interval 0.38 to 2.03), major adverse events (odds ratio 1.09, 95% confidence interval 0.61 to 1.96), postoperative myocardial infarction (p = 0.70), or stroke (p = 0.57). At a mean follow-up of 1.57 years, preoperative statin therapy was not associated with decreased mortality (p = 0.81). In the analysis using propensity score matching (354 propensity-matched patients, 177 in each group), preoperative statin was not associated with improved primary or secondary outcomes. In conclusion, preoperative statin therapy was not associated with a decrease in morbidity or mortality in patients undergoing isolated cardiac valve surgery.
术前使用他汀类药物与冠状动脉旁路移植术后死亡率降低有关。关于这些益处是否适用于接受心脏瓣膜手术的患者，数据有限。我们研究了术前使用他汀类药物是否能降低接受单纯心脏瓣膜手术患者的发病率和死亡率。在对在圣卢克圣公会医院接受手术瓣膜修复或置换（不包括同期冠状动脉旁路移植术、主动脉根部置换术或心室辅助装置置入术）的连续患者进行的回顾性队列分析中，主要结局是30天死亡率。次要结局包括30天主要不良事件（早期死亡率、术后心肌梗死或中风的综合）。在825例患者中，31%接受了术前他汀类药物治疗（n = 255）。逻辑回归分析显示，年龄>65岁（p = 0.02）、充血性心力衰竭病史（p = 0.001）和总旁路时间>80分钟（p = 0.01）是30天死亡率增加的独立预测因素。术前他汀类药物治疗与30天死亡率降低（比值比0.89，95%置信区间0.38至2.03）、主要不良事件（比值比1.09，95%置信区间0.61至1.96）、术后心肌梗死（p = 0.70）或中风（p = 0.57）无关。在平均随访1.57年时，术前他汀类药物治疗与死亡率降低无关（p = 0.81）。在使用倾向评分匹配的分析中（354例倾向匹配患者，每组177例），术前他汀类药物与主要或次要结局改善无关。总之，术前他汀类药物治疗与接受单纯心脏瓣膜手术患者的发病率或死亡率降低无关。
