Wang Jiayang, Yuan Wen, Zhang Kui, Liu Nan, Liu Dong, Zhou Yujie
Department of Cardiac Surgery, Beijing An Zhen Hospital Capital Medical University, Beijing 100029, China.
Center for Cardiac Intensive Care, Beijing An Zhen Hospital Capital Medical University, Beijing 100029, China.
Cardiol Res Pract. 2020 Jan 14;2020:9519736. doi: 10.1155/2020/9519736. eCollection 2020.
The purpose of this cohort study was to investigate the independent relationship between preoperative statin therapy (PST) and postoperative severe multiorgan failure, measured by the Sequential Organ Failure Assessment (SOFA) maximum greater than 11, in high-risk patients undergoing isolated coronary artery bypass grafting (CABG).
The present study is a perspective, single-center, cohort analysis enrolling high-risk patients undergoing CABG from Jan 1, 2018, to Dec 31, 2018, in Beijing Anzhen hospital.
Among a total of 880 high-risk patients undergoing isolated CABG included in this study, 503 (57.2%) experienced statin therapy before CABG. The SOFA maximum was significantly lower in the PST group compared with the control group (7.8 ± 3.0 v 9.2 ± 3.4, < 0.0001). Multivariate logistic regression analysis demonstrated the incidence of the severe multiorgan dysfunction, measured by SOFA maximum ≥11, was dramatically reduced in the PST group (OR, 0.68, 95% CI 0.50-0.92, =0.013). Furthermore, preoperative statin therapy (PST) might be associated with a decreased risk of postoperative major adverse cardiovascular and cerebral events and acute kidney injury, but an increased risk of postoperative hepatic inadequacy.
SOFA maximum was significantly lower in the PST group compared with the control group and the incidence of the severe multiorgan dysfunction was dramatically reduced in the PST group. The findings of this study might shed new light on questions of positive or negative effects of PST on multiple organ function after high-risk CABG, so as to ultimately improve high-risk patient in-hospital outcomes from CABG.
本队列研究的目的是调查在接受单纯冠状动脉旁路移植术(CABG)的高危患者中,术前他汀类药物治疗(PST)与术后严重多器官功能衰竭(通过序贯器官衰竭评估(SOFA)最大值大于11来衡量)之间的独立关系。
本研究是一项前瞻性、单中心队列分析,纳入了2018年1月1日至2018年12月31日在北京安贞医院接受CABG的高危患者。
在本研究纳入的总共880例接受单纯CABG的高危患者中,503例(57.2%)在CABG术前接受了他汀类药物治疗。PST组的SOFA最大值显著低于对照组(7.8±3.0对9.2±3.4,<0.0001)。多因素逻辑回归分析表明,PST组中以SOFA最大值≥11衡量的严重多器官功能障碍的发生率显著降低(OR,0.68,95%CI 0.50-0.92,=0.013)。此外,术前他汀类药物治疗(PST)可能与术后主要不良心血管和脑血管事件及急性肾损伤风险降低有关,但与术后肝功能不全风险增加有关。
PST组的SOFA最大值显著低于对照组,且PST组严重多器官功能障碍的发生率显著降低。本研究结果可能为PST对高危CABG术后多器官功能的正负影响问题提供新的线索,从而最终改善高危患者CABG的院内结局。