HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Matthias Thielmann Markus Kamler Parwis Massoudy Raimund Erbel Heinz Jakob Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thielmann, M. Articles by Jakob, H. Search for Related Content PubMed Articles by Thielmann, M. Articles by Jakob, H. Related Collections Coronary disease Myocardial infarction

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).

	Abstract

Top Abstract Introduction Materials and Methods Results Discussion References

 
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.

	Introduction

Top Abstract Introduction Materials and Methods Results Discussion References

 
Hyperlipidemia is known as one of the major risk factors associated with vascular endothelial injury, causing atherosclerotic plaque formation and coronary artery disease (CAD) that result in recurrent ischemic cardiovascular events.¹ Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, statins, are recognized as powerful lipid-lowering drugs that have been proved highly effective in primary and secondary prevention of CAD, decreasing low-density lipoprotein cholesterol (LDL-C) levels and thereby reducing the risk of mortality and cardiovascular adverse events in hyperlipidemic and normocholesterolemic patients.² In terms of surgical intervention, preoperative statin therapy has recently been shown to reduce the risk of early mortality in noncardiac^3-5 and cardiac^6-9 operations, suggesting early beneficial effects of statin treatment, irrespective of hyperlipidemia. To further differentiate lipid-dependent early beneficial statin effects, we sought to determine whether preoperative statin therapy might be associated with a reduced risk of postoperative death or major adverse cardiac events (MACEs) in patients with hyperlipidemia undergoing CABG and whether statin-untreated normolipidemic patients might have in turn an increased risk for postoperative death and MACEs after CABG.

	Materials and Methods

Top Abstract Introduction Materials and Methods Results Discussion References

 
Study Design
This study was a retrospective single-center cohort study including 3346 consecutive patients who underwent first-time isolated elective CABG at the West German Heart Center Essen between January 2000 and March 2006. Patients were included in and classified into one of 3 groups, depending on whether they had statin-untreated hyperlipidemia (group 1), statin-treated hyperlipidemia (group 2), or statin-untreated normolipidemia (group 3) before CABG surgery. The most recent levels of total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglyceride in serum within 1 month before surgical intervention were recorded. Hyperlipidemia was defined as a serum total cholesterol level of 200 mg/dL or greater and/or a low-density lipoprotein level of 130 mg/dL or greater and/or use of lipid-lowering statin therapy with a history of hyperlipidemia. Preoperative statin therapy consisted of one the following statins before CABG: pravastatin, simvastatin, fluvastatin, atorvastatin, cerivastatin, or lovastatin. Surgical revascularization was routinely performed as previously described¹⁰ in all patients by using a median sternotomy, a standard CPB technique with ascending aortic and 2-stage venous cannulation, mild hypothermia (>32°C), and cold crystalloid cardioplegic arrest. Off-pump coronary operations, emergency or urgent surgical intervention, previous myocardial infarction (<4 weeks) before CABG, reoperative procedures, or concomitant operations were the exclusion criteria. The institutional review board approved the study. All of the patients had previously granted permission for use of their medical records for research purposes.

Data Collection
Data used in this analysis were retrieved from the West German Heart Center cardiovascular surgical database. This database prospectively collects a comprehensive list of prespecified data points, with more than 1800 data items per patient for all of the consecutive patients undergoing CABG surgery at our institution, including demographic, clinical, and outcome data. Within the database, patients were coded as having statin-untreated hyperlipidemia, statin-treated hyperlipidemia, or statin-untreated normolipidemia.

Outcome Measures
All outcome measures used in this analysis were prespecified. Given the subject nature of many clinical outcomes, we only prespecified all-cause in-hospital mortality after CABG as the primary study end point. The prespecified secondary end point was the MACE rate, including sudden cardiac death, cardiac death, low cardiac output syndrome (LCOS), and perioperative myocardial infarction (PMI), during the postoperative hospitalization period. An independent review of the medical records of the patients who died after CABG operations was performed, and cardiac versus noncardiac cause of death was adjudicated.

Definitions
In-hospital death was defined as death after CABG during the index hospitalization. A PMI was considered to have occurred if one of the following diagnostic criteria were present: (1) a cardiac troponin I level of greater than 10.5 ng/mL after CABG, as previously described¹¹; (2) a creatine kinase–MB level 3 times greater than the upper normal level; (3) new persistent ST-segment or T-wave changes (Minnesota code 4-1, 4-2, 5-1, 5-2, or 9-2); or (4) the development of new Q-waves (Minnesota code 1-1-1 to 1-2-7). LCOS was supposed with a cardiac index of less than 2.0 L · min^–1 · m^–2 or a systolic arterial pressure of less than 90 mm Hg, despite high-dose inotropic support (intravenous dopamine, 8 µg · kg^–1 · min^–1; dobutamine, 6 µg · kg^–1 · min^–1; epinephrine, >0.1 µg · kg^–1 · min^–1; or norepinephrine, >0.1 µg · kg^–1 · min^–1). Death was considered cardiac if it was caused by PMI, significant cardiac arrhythmias, or refractory LCOS. Sudden unexpected death occurring without another explanation was defined as sudden cardiac death.

Statistical Analysis
Descriptive statistics are summarized for categoric variables as frequencies (percentages) and compared between groups by using the Pearson ² exact test. Continuous variables, expressed as means ± standard deviations or as medians (interquartile ranges), were compared between groups by using the Kruskal–Wallis test. When a significant overall effect was detected, 2 group comparisons were performed with the Fisher exact test or the Mann–Whitney U test. Univariate and multivariate logistic regression were performed to identify preoperative independent predictors for in-hospital mortality and MACEs. Those variables identified by means of univariate regression analysis with a P value of .05 or less for at least 1 study end point were added to the multivariate logistic regression model. Propensity score matching was performed to control for selection bias as a result of nonrandom assignment to the 3 groups.¹² The propensity scores were calculated separately, comparing group 1 versus group 2 and group 1 versus group 3. The following patient characteristics and major preoperative risk factors were used to calculate propensity scores: age, sex, diabetes, hypertension, hyperlipidemia, left ventricular ejection fraction, renal disease, previous myocardial infarction, left main disease, chronic obstructive pulmonary disease, peripheral vascular disease, angina class III ot IV, aspirin and ß-blocker use, and the number of bypassed vessels. For both comparisons, patients with similar propensity scores were combined into 20 matched sets of equal size. Once patients were matched, conditional logistic regression was used.¹³ All statistical analyses were performed with the SAS System, version 8 (SAS Institute, Inc, Cary, NC).

	Results

Top Abstract Introduction Materials and Methods Results Discussion References

 
Of the 3346 patients included in the present analysis, 167 hyperlipidemic patients underwent CABG surgery without preoperative statin therapy in group 1, whereas 2592 hyperlipidemic patients were taking statin therapy before surgical intervention in group 2, and 587 patients were normolipidemic without statins before surgical intervention in group 3. Preoperative characteristics of the patients are presented in Table 1. Patients were not significantly different according to their demographics, risk factors, and comorbidities, except for age and a higher number of patients with hypertension in group 2 compared with those in groups 1 and 3. Patients did not differ according to their cardiac history and their extent of CAD, but statin-treated patients received significantly more ß-blockers and tended to have more aspirin use compared with the statin-untreated hyperlipidemic and normolipidemic patients. Preoperative lipid levels showed a significant difference in the total cholesterol level, as well as the LDL-C levels, of statin-untreated group 1 compared with statin-treated group 2, whereas high-density lipoprotein cholesterol and triglyceride levels did not show any statistical difference between the groups. Intraoperative results did not differ between the groups (Table 2). As a result, the usual postoperative outcome data, such as length of ventilation time and intensive care unit and hospital stay, did not differ between the groups. The incidence of postoperative complications, such as postoperative stroke, supraventricular or ventricular arrhythmias, rethoracotomy, and other complications, were also not different (Table 2).

View larger version (12K): [in this window] [in a new window]   Figure 1. Incidence of death and major adverse cardiac events (MACE) during the hospital stay. P values indicate overall significance between groups 1 and 2 calculated by using the Pearson 2 exact test. OR, Odds ratio; CI, confidence interval.

View larger version (14K): [in this window] [in a new window]   Figure 2. Incidence of secondary end points during the hospital stay. P values indicate overall significance between groups 1 and 2 calculated by using the Pearson 2 exact test. OR, Odds ratio; CI, confidence interval; LCOS, low cardiac output syndrome; PMI, perioperative myocardial infarction.

	Discussion

Top Abstract Introduction Materials and Methods Results Discussion References

 
The present study is the first to clearly demonstrate that preoperative statin therapy is significantly associated with a risk reduction of in-hospital MACEs, particularly nonfatal PMI, in patients with hyperlipidemia undergoing CABG surgery. However, preoperative statin therapy is not associated with reduced in-hospital mortality compared with that seen in statin-untreated hyperlipidemic or normolipidemic patients. Conversely, the present study also demonstrates that statin-untreated normolipidemic patients are not at any short-term increased risk, either for in-hospital mortality or for MACEs, compared with statin-treated hyperlipidemic patients. Finally, preoperative statin therapy does not seem to be superior in terms of reduced early mortality and MACE rate compared with values seen in statin-untreated normolipidemic patients, suggesting that these early beneficial statin effects predominantly seem to be due to their lipid-lowering properties.

Numerous clinical trials have demonstrated that decreasing LDL-C levels is highly effective in primary and secondary prevention of CAD by substantially reducing the risk of adverse cardiovascular events, particularly in selected groups of patients with hyperlipidemia,² familial atherosclerosis,¹⁴ a previous history of CABG,^15,16 or acute coronary syndromes¹⁷ or during coronary interventions,¹⁸ but favorable statin effects are also seen, irrespective of baseline LDL-C levels and the presence or absence of other cardiac risk factors.¹⁹ There is also evidence that coronary plaque’s inflammatory characteristics strongly influence the likelihood of plaque rupture, which is at highest risk in hyperlipidemic patients. Plaque rupture occurs either spontaneously or as a result of coronary manipulation (by means of percutaneous coronary intervention or CABG surgery), causing microinfarctions with myocardial inflammatory response as a result of microembolization,²⁰ which in turn is reduced in patients undergoing statin treatment.^17,20-22 In the setting of cardiac surgery, preoperative statin therapy has been proved effective in several recent clinical studies by reducing the release of proinflammatory cytokines, thus attenuating postoperative inflammatory reactions after cardiac surgery with cardiopulmonary bypass.^23,24 Moreover, several recent large-scale observational cohort studies analyzed whether favorable effects of preoperative statins might exist, irrespective of whether patients had preoperatively increased LDL-C levels or hyperlipidemia.^6-9 However, most of the recent large-scale clinical trials analyzed the efficacy of preoperative statin treatment by pooling those patients with increased LDL-C levels and statin-untreated hyperlipidemia, which is the primary target of lipid-lowering statin therapy, with statin-untreated normolipidemic patients and therefore failed to define the outcome in statin-untreated normolipidemic patients. Moreover, to date, little is known about the potential early benefit of serum cholesterol reduction in more defined subgroups of patients undergoing CABG with hyperlipidemia and CAD undergoing surgical intervention. The present study therefore precisely defined the study groups, not only focusing on preoperative statin treatment but also considering the preoperative lipid levels, which were not addressed in the previous statin outcome studies performed in patients undergoing CABG surgery.^6-9 Thus we could clearly demonstrate that early beneficial effects of preoperative statin therapy, resulting in a significantly reduced incidence of PMI, only exist in statin-treated hyperlipidemic patients after CABG.

Although normolipidemic patients who did not receive preoperative statins had no increase in MACEs in this series, results from other CABG studies^6-9,16 and those of patients with acute coronary syndromes²⁵ would suggest that all patients undergoing CABG, irrespective of their baseline LDL-C levels, might benefit form perioperative and long-term statin therapy. Although some of those patients might not exhibit immediate short-term benefits, the present study did not examine long-term MACEs and the incidence of future cardiovascular events. It is likely that this cohort of patients will also benefit from the reduction of long-term MACEs by instituting perioperative statin therapy, despite their lower preoperative LDL-C levels.

The major limitation of the present study is its retrospective and nonrandomized design. Additionally, there are several important preoperative group differences in clinical characteristics and risk factors, as well as in the unequal study group size itself. Furthermore, statin-untreated hyperlipidemic patients might well be identified as a surrogate for patients receiving "substandard preoperative medical care" and therefore be vulnerable to other untreated maladies. We therefore accounted for these differences by means of careful statistical adjustment, using multivariate risk-adjusted and propensity score–adjusted regression models. In addition, the small sample size of statin-untreated patients during the observation period of more than 6 years indicates today’s widespread and highly established use of statins. Furthermore, the effect of precise preoperative statin therapy, considering the dose and duration, before CABG was not analyzed and should be addressed in future studies.

	Footnotes

 
Supported by a research grant of the "Kulturstiftung Essen e.V.," Essen, Germany.

	References

Top Abstract Introduction Materials and Methods Results Discussion References

 

1. Cholesterol Treatment Trialists Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90.056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-1278.[Medline]
   
2. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301-1308.[Medline]
   
3. Poldermans D, Bax JJ, Kertai, MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation 2003;107:1848-1851.[Abstract/Free Full Text]
   
4. O’Neil-Callahan K, Katsimaglis G, Tepper MR, et al. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol 2005;45:336-342.[Abstract/Free Full Text]
   
5. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004;39:967-975.[Medline]
   
6. Pan W, Pintar T, Anton J, et al. Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. Circulation 2004;110:II45-II49.[Medline]
   
7. Clark LL, Ikonomidis JS, Crawford J, et al. Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study. J Thorac Cardiovasc Surg 2006;131:679-685.[Abstract/Free Full Text]
   
8. Collard CD, Body SC, Shernan SK, et al. Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2006;132:392-400.[Abstract/Free Full Text]
   
9. Powell BD, Bybee KA, Valeti U, et al. Influence of preoperative lipid-lowering therapy on postoperative outcome in patients undergoing coronary artery bypass grafting. Am J Cardiol 2007;99:785-789.[Medline]
   
10. Thielmann M, Leyh R, Massoudy P, et al. Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery. Circulation 2006;114(suppl):I441-I447.[Medline]
    
11. Thielmann M, Massoudy P, Schmermund A, et al. Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery. Eur Heart J 2005;26:2440-2447.[Abstract/Free Full Text]
    
12. Brookmeyer R, Liang K, Linet M. Matched case-control designs and overmatched analyses. Am J Epidemiol 1986;124:693-701.[Abstract/Free Full Text]
    
13. Neuhäuser M, Becher H. Improved odds ratio estimation by post hoc stratification of case-control data. Stat Med 1997;16:993-1004.[Medline]
    
14. Stein EA, Illingworth DR, Kwiterovich Jr PO, et al. Efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia: a randomized controlled trial. JAMA 1999;281:137-144.[Abstract/Free Full Text]
    
15. The Post Coronary Artery Bypass Graft Trial Investigators The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med 1997;336:153-163.[Medline]
    
16. Campeau L, Hunninghake DB, Knatterud GL, et al. Aggressive cholesterol lowering delays saphenous vein graft atherosclerosis in women, the elderly, and patients with associated risk factors: NHLBI Post Coronary Artery Bypass Graft Clinical Trial. Circulation 1999;99:3241-3247.[Abstract/Free Full Text]
    
17. Lenderink T, Boersma E, Gitt AK, et al. Patients using statin treatment within 24 h after admission for ST-elevation acute coronary syndromes had lower mortality than non-users: a report from the first Euro Heart Survey on acute coronary syndromes. Eur Heart J 2006;27:1799-1804.[Abstract/Free Full Text]
    
18. Herrmann J, Lerman A, Baumgart D, et al. Preprocedural statin medication reduces the extent of periprocedural non-Q-wave myocardial infarction. Circulation 2002;106:2180-2183.[Abstract/Free Full Text]
    
19. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Circulation 2004;110:227-239.[Abstract/Free Full Text]
    
20. Erbel R, Heusch G. Brief review: coronary microembolization. J Am Coll Cardiol 2000;36:22-24.[Free Full Text]
    
21. Herrmann J. Peri-procedural myocardial injury: 2005 update. Eur Heart J 2005;26:2493-2519.[Abstract/Free Full Text]
    
22. Briguori C, Colombo A, Airoldi F, et al. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction. Eur Heart J 2004;25:1822-1828.[Abstract/Free Full Text]
    
23. Chello M, Anselmi A, Spadaccio C, et al. Simvastatin increases neutrophil apoptosis and reduces inflammatory reaction after coronary surgery. Ann Thorac Surg 2007;83:1374-1380.[Abstract/Free Full Text]
    
24. Liakopoulos OJ, Dorge H, Schmitto JD, et al. Effects of preoperative statin therapy on cytokines after cardiac surgery. Thorac Cardiovasc Surg 2006;54:250-254.[Medline]
    
25. Pascual DA, Arribas JM, Tornel PL, et al. Preoperative statin therapy and troponin T predict early complications of coronary artery surgery. Ann Thorac Surg 2006;81:78-83.[Abstract/Free Full Text]
    

This article has been cited by other articles:

				Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Thorac. Cardiovasc. Surg., January 1, 2012; 143(1): 4 - 34. [Full Text] [PDF]

				L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. Special Article: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Anesth. Analg., January 1, 2012; 114(1): 11 - 45. [Full Text] [PDF]

				L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): 2584 - 2614. [Full Text] [PDF]

				L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): e123 - e210. [Full Text] [PDF]

				Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): e652 - e735. [Full Text] [PDF]

				Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): 2610 - 2642. [Full Text] [PDF]

				E. W. Kuhn, O. J. Liakopoulos, Y. H. Choi, and T. Wahlers Current Evidence for Perioperative Statins in Cardiac Surgery Ann. Thorac. Surg., July 1, 2011; 92(1): 372 - 379. [Abstract] [Full Text] [PDF]

				D. Bouchard, M. Carrier, P. Demers, R. Cartier, M. Pellerin, L. P. Perrault, and J. Lambert Statin in Combination With {beta}-Blocker Therapy Reduces Postoperative Stroke After Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., March 1, 2011; 91(3): 654 - 659. [Abstract] [Full Text] [PDF]

				S. Mithani, M. Kuskowski, Y. Slinin, A. Ishani, E. McFalls, and S. Adabag Dose-Dependent Effect of Statins on the Incidence of Acute Kidney Injury After Cardiac Surgery Ann. Thorac. Surg., February 1, 2011; 91(2): 520 - 525. [Abstract] [Full Text] [PDF]

				M. Vaduganathan, N. J. Stone, R. Lee, E. C. McGee Jr., S. C. Malaisrie, R. A. Silverberg, and P. M. McCarthy Perioperative statin therapy reduces mortality in normolipidemic patients undergoing cardiac surgery J. Thorac. Cardiovasc. Surg., November 1, 2010; 140(5): 1018 - 1027. [Abstract] [Full Text] [PDF]

				M. A. Borger, J. Seeburger, T. Walther, F. Borger, A. Rastan, T. Doenst, and F. W. Mohr Effect of Preoperative Statin Therapy on Patients Undergoing Isolated and Combined Valvular Heart Surgery Ann. Thorac. Surg., March 1, 2010; 89(3): 773 - 780. [Abstract] [Full Text] [PDF]

				O. J. Liakopoulos, Y.-H. Choi, E. W. Kuhn, T. Wittwer, M. Borys, N. Madershahian, G. Wassmer, and T. Wahlers Statins for prevention of atrial fibrillation after cardiac surgery: A systematic literature review J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 678 - 686. [Abstract] [Full Text] [PDF]

				O. J. Liakopoulos, G. Wassmer, and T. Wahlers Still without impact on adverse post-operative outcomes: pre-operative statin therapy in patients undergoing cardiac surgery: reply Eur. Heart J., October 1, 2008; 29(19): 2444 - 2445. [Full Text] [PDF]

				N. Zimmermann, E. Gams, and T. Hohlfeld Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent Eur J Cardiothorac Surg, July 1, 2008; 34(1): 93 - 108. [Abstract] [Full Text] [PDF]

				O. J. Liakopoulos, Y.-H. Choi, P. L. Haldenwang, J. Strauch, T. Wittwer, H. Dorge, C. Stamm, G. Wassmer, and T. Wahlers Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30 000 patients Eur. Heart J., June 2, 2008; 29(12): 1548 - 1559. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Matthias Thielmann Markus Kamler Parwis Massoudy Raimund Erbel Heinz Jakob Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thielmann, M. Articles by Jakob, H. Search for Related Content PubMed Articles by Thielmann, M. Articles by Jakob, H. Related Collections Coronary disease Myocardial infarction