CLINICAL RESEARCH: CLINICAL TRIALS
Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery
The Statins for Risk Reduction in Surgery (StaRRS) study
Kristin O'Neil-Callahan, MD ,
George Katsimaglis, MD*, ,
Micah R. Tepper, MD,
Jason Ryan, MD,
Carla Mosby, MD,
John P.A. Ioannidis, MD||,¶ and
Peter G. Danias, MD, PhD*,, ,*
* Cardiovascular Division
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Second Cardiology Clinic, Hygeia Hospital, Athens, Greece
Naval Hospital, Athens, Greece
|| Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts
¶ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
Manuscript received September 2, 2004;
revised manuscript received October 13, 2004,
accepted October 18, 2004.
* Reprint requests and correspondence: Dr. Peter G. Danias, Hygeia Hospital, 4 Erythrou Stavrou Street and Kifissias Avenue, Maroussi 15123 Greece
(Email: pdanias{at}hygeia.gr; pdanias{at}bidmc.harvard.edu).
OBJECTIVES: We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery.
BACKGROUND: Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter.
METHODS: A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect.
RESULTS: Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p = 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p = 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins.
CONCLUSIONS: Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.
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Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | CAD = coronary artery disease | | CI = confidence interval | | MI = myocardial infarction | | OR = odds ratio |
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