Guay Joanne, Ochroch E Andrew
Department of Anesthesiology, University of Montreal, Montreal, Quebec, Canada.
Department of Anesthesiology, University of Pennsylvania Health System, Philadelphia, PA.
J Cardiothorac Vasc Anesth. 2014 Apr;28(2):255-66. doi: 10.1053/j.jvca.2013.03.007. Epub 2013 Sep 5.
To re-evaluate the effects of adding a statin before surgery on mortality at 30 days and at 1 year and on major morbidity at 0-30 days.
A meta-analysis of parallel, randomized, controlled trials published in English.
A university-based electronic search.
Adult patients undergoing any type of procedure.
Adding a statin before a procedure compared to a placebo or no intervention.
A search for all randomized controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the Cochrane Central Register of Controlled Trials in November 2012. The quality of each study was assessed with the Cochrane Collaboration Tools. An I-square ≥ 25% was chosen as the cut-off point for heterogeneity exploration. The search produced 29 trials. Statins reduced the 0-30 days' risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61); I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95), acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10 (0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26 (0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was slightly decreased with atorvastatin: standardized mean difference (SMD) -0.27 (-0.39, -0.14), p<0.001; fluvastatin SMD -0.95 (-1.56, -0.34), p = 0.002; and rosuvastatin SMD -0.69 (-0.98, -0.40), p<0.001 but not with simvastatin SMD -0.04 (-0.41, 0.48).
Adding a statin before a high risk cardiac procedure reduces the 0-30 days' risk of myocardial infarction.
重新评估术前加用他汀类药物对30天及1年死亡率以及0至30天主要并发症的影响。
对以英文发表的平行、随机、对照试验进行荟萃分析。
基于大学的电子检索。
接受任何类型手术的成年患者。
术前加用他汀类药物与安慰剂或无干预措施进行比较。
2012年11月在PubMed、Embase、Ovid MEDLINE和Cochrane对照试验中央注册库中检索所有随机对照试验（RCT）。使用Cochrane协作工具评估每项研究的质量。选择I²≥25%作为探索异质性的分界点。检索得到29项试验。他汀类药物降低了0至30天内心肌梗死风险：风险比（RR）0.48（95%CI 0.38，0.61）；I² 13.2%；p<0.001；需治疗人数17（14，24）。0至30天内，中风RR 0.70（0.25，1.95）、急性肾功能不全RR 0.54（0.26，1.12）或再次手术RR 1.10（0.51，2.38）无统计学差异。术后1年死亡率有降低趋势RR 0.26（0.06，1.02）；I² 0%；p = 0.053。阿托伐他汀使住院时间略有缩短：标准化均数差（SMD）-0.27（-0.39，-0.14），p<0.001；氟伐他汀SMD -0.95（-1.56，-0.34），p = 0.002；瑞舒伐他汀SMD -0.69（-0.98，-0.40），p<0.001，但辛伐他汀无此作用SMD -0.04（-0.41，0.48）。
高危心脏手术前加用他汀类药物可降低0至30天内心肌梗死风险。
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