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J Thorac Cardiovasc Surg 2007;134:1143-1149
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Lipid-lowering effect of preoperative statin therapy on postoperative major adverse cardiac events after coronary artery bypass surgery

^a Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany
^c Department of Cardiology, West German Heart Center Essen, University Hospital Essen, Essen, Germany
^b Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany.

Read at the 79th Scientific Sessions of the American Heart Association, Chicago, Ill, November 12-15, 2006.

Received for publication April 17, 2007; revisions received July 14, 2007; accepted for publication July 26, 2007.

^_* Address for reprints: Matthias Thielmann, MD, Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Hufelandstraße 55, 45122 Essen, Germany. (Email: matthias.thielmann{at}uni-due.de).

Objective: Statins are powerful lipid-lowering drugs that have been proved effective in the prevention of coronary artery disease, clearly reducing the risk of mortality and cardiovascular events. Whether hyperlipidemic patients undergoing coronary artery bypass grafting profit from the lipid-lowering beneficial effects of statins is as yet uncertain. We sought to determine whether preoperative statin therapy may have an effect on outcome among hyperlipidemic patients undergoing coronary artery bypass grafting.

Methods: From January 2000 through March 2006, prospectively recorded clinical data from 3346 consecutive patients undergoing isolated first-time elective coronary artery bypass grafting were analyzed for major adverse cardiac events and all-cause in-hospital mortality. Of these, 167 patients had preoperative statin-untreated hyperlipidemia (group 1), 2592 had statin-treated hyperlipidemia (group 2), and 587 had statin-untreated normolipidemia (group 3).

Results: Risk-adjusted multivariate logistic regression analysis revealed statin-treated hyperlipidemia (odds ratio, 0.42; 95% confidence interval, 0.26-0.69; P = .0007) and statin-untreated normolipidemia (odds ratio, 0.42; confidence interval, 0.26-0.69; P = .0007) to be independently associated with reduced in-hospital major adverse cardiac events but not with in-hospital mortality. To further control for selection bias, a computed propensity score matching based on 14 major preoperative risk factors was performed. After propensity matching, conditional logistic regression analysis confirmed statin-treated hyperlipidemia and statin-untreated normolipidemia to be strongly related to reduced in-hospital major adverse cardiac events (odds ratio, 0.41; 95% confidence interval, 0.24–0.71 [P = .0013] and odds ratio, 0.23; 95% confidence interval, 0.11–0.48 [P = .0001]) but not with in-hospital mortality (odds ratio, 1.18; 95% confidence interval, 0.36–3.87 [P = .79] and odds ratio, 1.10; 95% confidence interval, 0.32–4.41 [P = .80]) after coronary artery bypass grafting surgery.

Conclusions: Hyperlipidemic, but not normolipidemic, patients have an increased risk for in-hospital major adverse cardiac events and therefore clearly benefit from preoperative statin therapy before coronary artery bypass grafting surgery.

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