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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Intensity of Statin Therapy in Relation to Myocardial Ischemia, Troponin T Release, and Clinical Cardiac Outcome in Patients Undergoing Major Vascular Surgery

Harm H.H. Feringa, MD^_*, Olaf Schouten, MD, Stefanos E. Karagiannis, MD^_*, Jasper Brugts, MD^_*, Abdou Elhendy, MD, Eric Boersma, PhD^_*, Radosav Vidakovic, MD^_*, Marc R.H.M. van Sambeek, MD, Peter G. Noordzij, MD, Jeroen J. Bax, MD^¶ and Don Poldermans, MD^,_*

^_* Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands,
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Marshfield Clinics, Marshfield, Wisconsin
^¶ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands

Manuscript received May 15, 2007; revised manuscript received June 20, 2007, accepted June 21, 2007.

^_* Reprint requests and correspondence: Dr. Don Poldermans, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. (Email: d.poldermans{at}erasmusmc.nl).

Objectives: This study sought to examine whether higher statin doses and lower low-density lipoprotein (LDL) cholesterol are associated with improved cardiac outcome in vascular surgery patients.

Background: Statins may have cardioprotective effects during major vascular surgery.

Methods: In a prospective study of 359 vascular surgery patients, statin dose and cholesterol levels were recorded preoperatively. Myocardial ischemia and heart rate variability were assessed by 72-h 12-lead electrocardiography starting 1 day before to 2 days after surgery. Troponin T was measured on postoperative day 1, 3, 7, and before discharge. Cardiac events included cardiac death or nonfatal Q-wave myocardial infarction at 30 days and follow-up (mean 2.3 years).

Results: Perioperative myocardial ischemia, troponin T release, 30-day events, and late cardiac events occurred in 29%, 23%, 4%, and 18%, respectively. In multivariate analysis, lower LDL cholesterol (per 10 mg/dl) correlated with lower myocardial ischemia (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80 to 0.95), troponin T release (OR 0.89, 95% CI 0.82 to 0.96), and 30-day (OR 0.89, 95% CI 0.78 to 1.00) and late cardiac events (hazard ratio 0.91, 95% CI 0.84 to 0.96). Higher statin doses (per 10% of maximum recommended dose) correlated with lower myocardial ischemia (OR 0.85, 95% CI 0.76 to 0.93), troponin T release (OR 0.84, 95% CI 0.76 to 0.93), and 30-day (OR 0.62, 95% CI 0.40 to 0.96) and late cardiac events (hazard ratio 0.76, 95% CI 0.65 to 0.89), even after adjusting for LDL cholesterol. Significantly higher perioperative heart rate variability was observed in patients with higher statin doses.

Conclusions: Higher statin doses and lower LDL cholesterol correlate with lower perioperative myocardial ischemia, perioperative troponin T release, and 30-day and late cardiac events in major vascular surgery.

Abbreviations and Acronyms   LDL = low-density lipoprotein   MRTD = maximum recommended therapeutic dose   NN = normal-to-normal   rMSSD = square root of the mean squared differences of successive normal-to-normal intervals   SDANN = standard deviation of the average normal-to-normal intervals   SDNN = standard deviation of the normal-to-normal intervals

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