Effect of preoperative statin therapy on patients undergoing isolated and combined valvular heart surgery.

Abstract

BACKGROUND It is unknown whether patients undergoing valve surgery benefit from preoperative statin therapy. We examined the effects of statin treatment in a large group of patients undergoing valve surgery. METHODS Between October 2001 and May 2008, a total of 10,061 patients underwent isolated or combined valve surgery at our institution. Patients were divided into those who received preoperative statin therapy (group 1, n = 4,216) versus those who did not receive statin therapy (group 2, n = 5,538). Patients in whom preoperative statin therapy status was unknown (n = 307) were excluded. Follow-up survival information was available in all patients. RESULTS Group 1 patients had more comorbidities, were more likely to undergo concomitant coronary artery bypass grafting (46.0% versus 20.7%; p < 0.001), and had a higher mean EuroSCORE predicted risk of mortality (12.4% +/- 13.5% versus 11.5% +/- 13.9%; p = 0.002). Patients receiving preoperative statin therapy had a higher incidence of low cardiac output syndrome (8.4% versus 6.0%; p < 0.001) and the combined cardiac outcome of myocardial infarction, low cardiac output syndrome, and 30-day mortality (11.8% versus 9.6%; p < 0.001) by univariate analysis. Multivariable analyses, however, revealed no significant effect of statin therapy on perioperative cardiac outcomes. Cox multivariable regression revealed no significant effect of statin therapy on long-term survival in the entire patient cohort, but statin therapy was associated with a long-term survival benefit (hazard ratio, 0.81; 95% confidence interval, 0.70 to 0.93; p = 0.003) in patients who underwent concomitant coronary artery bypass grafting. CONCLUSIONS Our large series failed to detect a protective effect of preoperative statin therapy on perioperative outcomes or long-term survival in patients undergoing isolated valve surgery. Valve patients undergoing concomitant coronary artery bypass grafting, however, appear to receive a long-term survival benefit from statins.

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