Effects of Adding Statins Before Surgery on Mortality and Major Morbidity: A Meta-Analysis

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 28; no. 2; pp. 255 - 266
• Main Authors: Guay, Joanne, MD, Ochroch, E. Andrew, MD, MSCE
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014
• Subjects: Adult; Anesthesia & Perioperative Care; Atorvastatin Calcium; Cardiac Surgical Procedures - mortality; Critical Care; death; Heptanoic Acids - adverse effects; Heptanoic Acids - therapeutic use; hospital; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; intensive care unit; Length of Stay; myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; Odds Ratio; Preoperative Care - methods; Publication Bias; Pyrroles - adverse effects; Pyrroles - therapeutic use; Randomized Controlled Trials as Topic; renal insufficiency; Risk Assessment; statins; stroke; surgery; Treatment Outcome; death; statins; renal insufficiency; myocardial infarction; length of stay; intensive care unit; hospital; stroke; surgery
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.03.007

Objective To re-evaluate the effects of adding a statin before surgery on mortality at 30 days and at 1 year and on major morbidity at 0-30 days. Design A meta-analysis of parallel, randomized, controlled trials published in English. Setting A university-based electronic search. Participants Adult patients undergoing any type of procedure. Intervention Adding a statin before a procedure compared to a placebo or no intervention. Measurements and Main Results A search for all randomized controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the Cochrane Central Register of Controlled Trials in November 2012. The quality of each study was assessed with the Cochrane Collaboration Tools. An I-square ≥25% was chosen as the cut-off point for heterogeneity exploration. The search produced 29 trials. Statins reduced the 0-30 days’ risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61); I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95), acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10 (0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26 (0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was slightly decreased with atorvastatin: standardized mean difference (SMD) −0.27 (−0.39, −0.14), p<0.001; fluvastatin SMD −0.95 (−1.56, −0.34), p = 0.002; and rosuvastatin SMD −0.69 (−0.98, −0.40), p<0.001 but not with simvastatin SMD −0.04 (−0.41, 0.48). Conclusions Adding a statin before a high risk cardiac procedure reduces the 0-30 days’ risk of myocardial infarction.