Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Clin Cardiol. 2013 Aug;36(8):456-61. doi: 10.1002/clc.22135. Epub 2013 May 13.
Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) reduce perioperative cardiac events in high-risk patients undergoing cardiovascular surgery. However, there is paucity of data on the role of statins in patients undergoing intermediate-risk noncardiac, nonvascular surgery (NCNVS).
Statins are cardioprotective in intermediate-risk NCNVS.
We identified a retrospective cohort of patients undergoing intermediate risk NCNVS. Our composite end point (CEP) included 30-day all-cause mortality, atrial fibrillation (AF), and nonfatal myocardial infarction (MI). A stepwise logistic regression with adjustment using propensity scores was performed to determine if statin therapy was independently associated with the risk reduction of adverse postoperative cardiovascular outcomes.
We identified 752 patients. Seventy-five of them (9.97%) developed composite end points; 10 (1.33%) had in-hospital nonfatal MI, 44 (5.85%) developed AF, and 35 (4.65%) died within 30 days. The 30-day all-cause mortality was 31/478 (6.48%) among statin nonusers vs 4/274 (1.45%) for statin users (P < 0.002). As compared with nonusers, patients on statin therapy had a 5-fold reduced risk of 30-day all-cause mortality. Statin therapy was associated with decreased CEP after adjusting for baseline characteristics, with a propensity score to predict use of statins (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.30-0.97, P = 0.039). After further adjustment for propensity score, diabetes mellitus, percutaneous coronary intervention, and prior coronary artery bypass grafting, statin therapy proved beneficial (OR: 0.51, 95% CI: 0.28-0.92, P = 0.026).
Statin use in the perioperative period was associated with a reduction in cardiovascular adverse events and 30-day all-cause mortality in patients undergoing intermediate-risk NCNVS.
羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）可降低接受心血管手术的高危患者围手术期的心脏事件。然而，在接受中危非心脏、非血管手术（NCNVS）的患者中，他汀类药物的作用数据很少。
他汀类药物在中危 NCNVS 中具有心脏保护作用。
我们确定了接受中危 NCNVS 的回顾性队列患者。我们的复合终点（CEP）包括 30 天全因死亡率、心房颤动（AF）和非致死性心肌梗死（MI）。使用倾向评分进行逐步逻辑回归分析，以确定他汀类药物治疗是否与术后不良心血管结局风险降低独立相关。
我们确定了 752 名患者。其中 75 名（9.97%）发生复合终点；10 名（1.33%）发生院内非致死性 MI，44 名（5.85%）发生 AF，35 名（4.65%）在 30 天内死亡。他汀类药物非使用者 30 天全因死亡率为 31/478（6.48%），而他汀类药物使用者为 4/274（1.45%）（P <0.002）。与非使用者相比，接受他汀类药物治疗的患者 30 天全因死亡率降低了 5 倍。在校正基线特征后，他汀类药物治疗与 CEP 降低相关，预测使用他汀类药物的倾向评分（比值比 [OR]：0.54，95%置信区间 [CI]：0.30-0.97，P = 0.039）。在校正倾向评分后，进一步调整糖尿病、经皮冠状动脉介入治疗和既往冠状动脉旁路移植术，他汀类药物治疗显示有益（OR：0.51，95% CI：0.28-0.92，P = 0.026）。
在接受中危 NCNVS 的患者中，围手术期使用他汀类药物与心血管不良事件和 30 天全因死亡率降低相关。
