Berwanger Otavio, Le Manach Yannick, Suzumura Erica Aranha, Biccard Bruce, Srinathan Sadeesh K, Szczeklik Wojciech, Santo Jose A Espirito, Santucci Eliana, Cavalcanti Alexandre B, Archbold R Andrew, Devereaux P J
Research Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Eur Heart J. 2016 Jan 7;37(2):177-85. doi: 10.1093/eurheartj/ehv456. Epub 2015 Sep 1.
The aim of this study was to assess the effects of pre-operative statin therapy on cardiovascular events in the first 30-days after non-cardiac surgery.
We conducted an international, prospective, cohort study of patients who were ≥45 years having in-patient non-cardiac surgery. We estimated the probability of receiving statins pre-operatively using a multivariable logistic model and conducted a propensity score analysis to correct for confounding. A total of 15 478 patients were recruited at 12 centres in eight countries from August 2007 to January 2011. The matched population consisted of 2845 patients (18.4%) treated with a statin and 4492 (29.0%) controls. The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73-0.95; P = 0.007]. Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02). There were no statistically significant differences in the risk of myocardial infarction or stroke.
Among patients undergoing non-cardiac surgery, pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days. These results require confirmation in a large randomized trial.
Clinical Trials.gov NCT00512109.
本研究旨在评估术前他汀类药物治疗对非心脏手术后30天内心血管事件的影响。
我们对年龄≥45岁的住院非心脏手术患者进行了一项国际前瞻性队列研究。我们使用多变量逻辑模型估计术前接受他汀类药物治疗的概率，并进行倾向评分分析以校正混杂因素。2007年8月至2011年1月期间，在八个国家的12个中心共招募了15478名患者。匹配人群包括2845名接受他汀类药物治疗的患者（18.4%）和4492名对照患者（29.0%）。术前使用他汀类药物与主要结局风险降低相关，主要结局为30天时的全因死亡率、非心脏手术后心肌损伤（MINS）或卒中的复合结局[相对风险（RR），0.83；95%置信区间（CI），0.73 - 0.95；P = 0.007]。他汀类药物还与全因死亡率显著降低相关（RR，0.58；95% CI，0.40 - 0.83；P = 0.003）、心血管死亡率（RR，0.42；95% CI，0.23 - 0.76；P = 0.004）和MINS（RR，0.86；95% CI，0.73 - 0.98；P = 0.02）。心肌梗死或卒中风险无统计学显著差异。
在接受非心脏手术的患者中，术前他汀类药物治疗与30天时较低的心血管结局风险独立相关。这些结果需要在大型随机试验中得到证实。
ClinicalTrials.gov NCT00512109。
