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术前使用他汀类药物与心脏手术后房颤风险降低无关。

Preoperative Statin use is not Associated with a Reduced Risk of Atrial Fibrillation After Cardiac Surgery.

作者信息

Barnes Brian J, Solomon Scott, Howard Patricia A, Lakkireddy Dhanunjaya, Kramer Jeffrey B, Muehlebach Gregory F, Daon Emmanuel, Zorn George L Trip, Vacek James L

机构信息

Department of Pharmacy Practice, School of Pharmacy, The University of Kansas, Kansas City, KS.

Mid-America Thoracic and Cardiovascular Surgery, Inc. The University of Kansas Hospital, Kansas City, KS.

出版信息

J Atr Fibrillation. 2011 May 4;4(1):325. doi: 10.4022/jafib.325. eCollection 2011 May-Jun.

Abstract

Postoperative atrial fibrillation (POAF) is prevalent after cardiac surgery and associated with significant morbidity and costs. Statins are commonly used in this population and may be a preventative strategy for PAOF. We wished to examine the effect of preoperative statin use on the risk of POAF after cardiac surgery. A retrospective, observational study was conducted using data from 489 adult patients who underwent cardiac surgery at a single institution. Univariate analyses and unconditional logistic regression were used to determine the impact of preoperative statin use on the probability of developing POAF, while controlling for the baseline risk of POAF and the use of amiodarone prophylaxis (AMP). A baseline risk index was calculated for each patient using a previously validated model. Patients with chronic atrial fibrillation or missing data were excluded. Mean patient age was 63 (SD=13) years, 73% were male, 68% underwent isolated coronary artery bypass grafting, 16% underwent isolated valve surgery, with 13% underwent combined CABG and valve surgeries, and 3% underwent other forms of cardiac surgery. POAF occurred in 27% of patients receiving statins and 24% of those not receiving statins (p=0.3792). After controlling for baseline risk of POAF and the use of AMP, we found that preoperative statins were not associated with reductions in POAF (OR=1.19, 95%CI=0.782-1.822, p=0.4118). Multiple factors impact the development of POAF after cardiac surgery including patient demographics, comorbidities, surgical type, and concomitant medications. In this study, after adjustment for these factors the preoperative use of statins did not significantly influence the development of POAF.

摘要

术后房颤(POAF)在心脏手术后很常见,且与显著的发病率和费用相关。他汀类药物常用于这一人群,可能是预防POAF的一种策略。我们希望研究术前使用他汀类药物对心脏手术后发生POAF风险的影响。我们进行了一项回顾性观察研究,使用了来自一家机构的489例接受心脏手术的成年患者的数据。采用单因素分析和无条件逻辑回归来确定术前使用他汀类药物对发生POAF概率的影响,同时控制POAF的基线风险和胺碘酮预防用药(AMP)的使用情况。使用先前验证的模型为每位患者计算基线风险指数。排除患有慢性房颤或数据缺失的患者。患者平均年龄为63(标准差=13)岁,73%为男性,68%接受单纯冠状动脉旁路移植术,16%接受单纯瓣膜手术),13%接受冠状动脉旁路移植术和瓣膜联合手术,3%接受其他形式的心脏手术。接受他汀类药物治疗的患者中27%发生POAF,未接受他汀类药物治疗的患者中24%发生POAF(p=0.3792)。在控制POAF的基线风险和AMP的使用后,我们发现术前使用他汀类药物与POAF发生率的降低无关(比值比=1.19,95%置信区间=0.782-1.822,p=0.4118)。多种因素影响心脏手术后POAF的发生,包括患者人口统计学特征、合并症、手术类型和伴随用药。在本研究中,在对这些因素进行调整后,术前使用他汀类药物并未显著影响POAF的发生。

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本文引用的文献

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Risk-stratified evaluation of amiodarone to prevent atrial fibrillation after cardiac surgery.
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