Universität zu Köln

Kuhn, Elmar W., Liakopoulos, Oliver J., Stange, Sebastian, Deppe, Antje-Christin, Slottosch, Ingo, Choi, Yeong-Hoon and Wahlers, Thorsten (2014). Preoperative statin therapy in cardiac surgery: a meta-analysis of 90 000 patients. Eur. J. Cardio-Thorac. Surg., 45 (1). S. 17 - 27. CARY: OXFORD UNIV PRESS INC. ISSN 1873-734X

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Abstract

The objective of this systematic literature review with meta-analysis was to determine the strength of evidence for a preoperative statin on the reduction of adverse postoperative outcomes in patients undergoing cardiac surgery. Randomized controlled (RCT) and observational trials were searched in online databases that reported about the effects of preoperative statin therapy on major adverse clinical outcomes after cardiac surgery. Analysed outcomes included early all-cause mortality, myocardial infarction, atrial fibrillation (AF), stroke and renal failure using a priori-defined criteria. Effect estimates were calculated and are given as odds ratio (OR) with 95% confidence intervals (95% CI) using fixed-or random-effect models. Literature search of all major databases retrieved 2371 studies. After screening, a total of 54 trials were identified (12 RCT, 42 observational) that reported outcomes of 91 491 cardiac surgery patients with (n = 46 614; 51%) or without (n = 44 877; 49%) preoperative statin therapy. Preoperative statin use resulted in a 0.9% absolute risk (2.6 vs 3.5%) and a 31% odds reduction for early all-cause mortality (OR 0.69; 95% CI 0.59-0.81; P < 0.0001). In addition, statin treatment before surgery was associated with a substantial reduction (P < 0.01) in the postoperative end-points AF (OR 0.71; 95% CI 0.61-0.82), new-onset AF (OR 0.68; 95% CI 0.54-0.85), stroke (OR 0.83; 95% CI 0.74-0.93), stay on intensive care unit (weighted mean difference [WMD] -0.14; 95% CI -0.23 to -0.03; P < 0.01) and in-hospital stay (WMD -0.57; 95% CI -0.76 to -0.38; P < 0.01). No statistical differences were found between groups with regard to myocardial infarction or renal failure. In conclusion, the current systematic review strengthens the evidence that preoperative statin therapy extends substantial clinical benefit to early postoperative outcomes in cardiac surgery patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kuhn, Elmar W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Liakopoulos, Oliver J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stange, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Deppe, Antje-Christin UNSPECIFIED UNSPECIFIED UNSPECIFIED Slottosch, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Choi, Yeong-Hoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-452048
DOI:	10.1093/ejcts/ezt181
Journal or Publication Title:	Eur. J. Cardio-Thorac. Surg.
Volume:	45
Number:	1
Page Range:	S. 17 - 27
Date:	2014
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	1873-734X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CORONARY-ARTERY-BYPASS; POSTOPERATIVE ATRIAL-FIBRILLATION; VALVULAR HEART-SURGERY; ACUTE KIDNEY INJURY; CARDIOPULMONARY BYPASS; CLINICAL-TRIALS; GRAFT-SURGERY; INFLAMMATORY RESPONSE; RANDOMIZED-TRIAL; OUTCOMES Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/45204