Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Ann Thorac Surg. 2011 Mar;91(3):654-9. doi: 10.1016/j.athoracsur.2010.11.036.
Statin therapy prior to coronary artery bypass surgery (CABG) has been shown to prevent perioperative events such as myocardial infarction and perioperative death. The effect of statin therapy as a preventive treatment to decrease the stroke risk unrelated to cardiac surgery is also documented. In the setting of CABG, we have found no studies reporting a preventive effect of statin therapy on neurologic outcome.
We analyzed 6,813 patients treated by CABG surgery at our institution between 1995 and 2005 for which complete medication history including all drugs taken before and after surgery was available. We analyzed the risk factors for postoperative stroke using a multiple logistic regression analysis, more specifically looking at the effect of preoperative treatment with statin, aspirin, β-blockers, and angiotensin-converting enzyme inhibitors, alone or in combination.
At 30 days postoperative, 94 patients suffered a new documented stroke (1.4%). Hypertension, carotid disease, diabetes, and age were all associated with a greater risk of postoperative stroke. When analyzing the four groups of drug therapy, none of the medications alone affected the stroke rate. However, upon multivariable analysis the combination of statin and β-blockers gave an odds ratio of 0.377, suggesting a strong protective effect.
Beta-blockers combined with statin confer a protective effect for stroke after CABG.
在冠状动脉旁路移植术 (CABG) 之前进行他汀类药物治疗已被证明可预防围手术期事件，如心肌梗死和围手术期死亡。他汀类药物治疗作为预防治疗以降低与心脏手术无关的中风风险的效果也有记录。在 CABG 中，我们尚未发现研究报告他汀类药物治疗对神经功能结果有预防作用。
我们分析了 1995 年至 2005 年期间在我们机构接受 CABG 手术治疗的 6813 例患者，这些患者的完整药物史，包括手术前后服用的所有药物，均可用。我们使用多变量逻辑回归分析分析了术后中风的危险因素，更具体地研究了术前使用他汀类药物、阿司匹林、β-受体阻滞剂和血管紧张素转换酶抑制剂单独或联合治疗的效果。
术后 30 天，94 例患者发生新的有记录的中风（1.4%）。高血压、颈动脉疾病、糖尿病和年龄均与术后中风风险增加相关。在分析四组药物治疗时，没有一种药物单独影响中风发生率。然而，经过多变量分析，他汀类药物和β-受体阻滞剂联合使用的优势比为 0.377，表明具有很强的保护作用。
β-受体阻滞剂联合他汀类药物可降低 CABG 后中风的风险。
