Open AccessStatin Therapy in the Reduction of Cardiovascular Events in Patients Undergoing Intermediate‐Risk Noncardiac, Nonvascular Surgery
Author(s) -
Raju Manjunath G.,
Pachika Ajay,
Punnam Sujeeth R.,
Gardiner Joseph C.,
Shishehbor Mehdi H.,
Kapadia Samir R.,
Abela George S.
Publication year - 2013
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22135
Subject(s) - medicine , statin , propensity score matching , myocardial infarction , percutaneous coronary intervention , odds ratio , retrospective cohort study , perioperative , cardiology , confidence interval , atrial fibrillation , coronary artery disease , diabetes mellitus , surgery , endocrinology
Background Hydroxymethylglutaryl‐coenzyme A reductase inhibitors (statins) reduce perioperative cardiac events in high‐risk patients undergoing cardiovascular surgery. However, there is paucity of data on the role of statins in patients undergoing intermediate‐risk noncardiac, nonvascular surgery ( NCNVS ). Hypothesis Statins are cardioprotective in intermediate‐risk NCNVS. Methods We identified a retrospective cohort of patients undergoing intermediate risk NCNVS . Our composite end point ( CEP ) included 30‐day all‐cause mortality, atrial fibrillation ( AF ), and nonfatal myocardial infarction ( MI ). A stepwise logistic regression with adjustment using propensity scores was performed to determine if statin therapy was independently associated with the risk reduction of adverse postoperative cardiovascular outcomes. Results We identified 752 patients. Seventy‐five of them (9.97%) developed composite end points; 10 (1.33%) had in‐hospital nonfatal MI , 44 (5.85%) developed AF , and 35 (4.65%) died within 30 days. The 30‐day all‐cause mortality was 31/478 (6.48%) among statin nonusers vs 4/274 (1.45%) for statin users ( P < 0.002). As compared with nonusers, patients on statin therapy had a 5‐fold reduced risk of 30‐day all‐cause mortality. Statin therapy was associated with decreased CEP after adjusting for baseline characteristics, with a propensity score to predict use of statins (odds ratio [ OR ]: 0.54, 95% confidence interval [ CI ]: 0.30–0.97, P = 0.039). After further adjustment for propensity score, diabetes mellitus, percutaneous coronary intervention, and prior coronary artery bypass grafting, statin therapy proved beneficial ( OR : 0.51, 95% CI : 0.28–0.92, P = 0.026). Conclusions Statin use in the perioperative period was associated with a reduction in cardiovascular adverse events and 30‐day all‐cause mortality in patients undergoing intermediate‐risk NCNVS .