a Department of Cardiology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China.
b Department of Oncology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China.
Ann Med. 2018 Aug;50(5):402-409. doi: 10.1080/07853890.2018.1471217. Epub 2018 May 15.
Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes.
We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.
Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes.
Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR) = 0.460, 95% confidence interval (CI) = 0.324-0.653, p = 0 for myocardial infarction; OR = 0.617, 95% CI = 0.476-0.801, p = 0 for composite of death/myocardial infarction/stroke; OR = 0.406, 95% CI = 0.247-0.666, p = 0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms.
This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery. Key Messages Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.
心血管并发症与非心脏手术后随访期间的死亡率升高密切相关。然而，围手术期使用羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）是否对患者预后有益仍存在争议。
我们进行了一项荟萃分析，以验证围手术期使用他汀类药物可改善非心脏手术后患者结局的假设。
检索电子数据库（PubMed、Web of Science、EMBASE 和 Cochrane Library），查找截至 2017 年 11 月 10 日发表的随机对照试验（RCT）。如果 RCT 将围手术期他汀类药物治疗与非心脏手术患者的对照治疗进行比较，并报告与临床结局相关的数据，则纳入研究。
最终纳入 12 项 RCT 共 4707 例患者（围手术期他汀组 2371 例，对照组 2336 例）。结果显示，与对照组相比，他汀类药物治疗组患者术后心肌梗死、死亡/心肌梗死/卒中复合终点和新发心房颤动的发生率均降低，差异有统计学意义（固定效应模型：心肌梗死发生率的比值比（OR）=0.460，95%置信区间（CI）=0.324-0.653，p=0；死亡/心肌梗死/卒中复合终点发生率的 OR=0.617，95%CI=0.476-0.801，p=0；新发心房颤动发生率的 OR=0.406，95%CI=0.247-0.666，p=0）。他汀组与对照组在卒中或短暂性脑缺血发作、全因死亡率和心血管死亡率方面无显著差异。
本荟萃分析支持围手术期使用他汀类药物可有效降低非心脏手术患者术后心肌梗死、死亡/心肌梗死/卒中复合终点和新发心房颤动的发生率的假设。
