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J Thorac Cardiovasc Surg 2006;131:679-685
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: An 8-year retrospective cohort study

^a Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
^b Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC
^c Division of Cardiology, Medical University of South Carolina, Charleston, SC

Received for publication June 1, 2005; revisions received August 26, 2005; accepted for publication August 30, 2005.

^_* Address for reprints: Francis G. Spinale, MD, PhD, Cardiothoracic Surgery, 114 Doughty St, Room 625, Medical University of South Carolina, Charleston, SC 29403. (Email: wilburnm{at}musc.edu).

BACKGROUND: Cardiac surgical procedures can be associated with significant morbidity and mortality. Recently, it has been recognized that statins might induce multiple biologic effects independent of lipid lowering that could potentially ameliorate adverse surgical outcomes. Accordingly, this study tested the central hypothesis that pretreatment with statins before cardiac surgery would reduce adverse postoperative surgical outcomes.

METHODS: Demographic and outcomes data were collected retrospectively for 3829 patients admitted for planned cardiac surgery between February 1994 and December 2002. Statin pretreatment occurred in 1044 patients who were comparable with non–statin-pretreated (n = 2785) patients with regard to sex, race, and age. Primary outcomes examined included postoperative mortality (30-day) and a composite morbidity variable.

RESULTS: The odds of experiencing 30-day mortality and morbidity were significantly less in the statin-pretreated group, with unadjusted odds ratios of 0.43 (95% confidence interval [CI], 0.28-0.66) and 0.72 (95% CI, 0.61-0.86), respectively. Risk-adjusted odds ratios for mortality and morbidity were 0.55 (95% CI, 0.32-0.93) and 0.76 (95% CI, 0.62-0.94), respectively, by using a logistic regression model and 0.51 (95% CI, 0.27-0.94) and 0.71 (95% CI, 0.55-0.92), respectively, in the propensity-matched model, demonstrating significant reductions in 30-day morbidity and mortality. In a subsample of patients undergoing valve-only surgery (n = 716), fewer valve-only patients treated with statins experienced mortality, although these results were not statistically significant (1.96% vs 7.5%).

CONCLUSIONS: These findings indicate that statin pretreatment before cardiac surgery confers a protective effect with respect to postoperative outcomes.

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