Statins before Surgery Cut Risk of Cardiac Complications

Administering statins before surgery in statin-naive patients lowered the risk of myocardial infarction (MI) and atrial fibrillation. The drugs also reduced the time patients were hospitalized, according to results of a recent meta-analysis [Arch Surg. 2012;147(2):181-189].

Cardiac complications remain a frequent problem in patients with cardiovascular risk factors undergoing high-risk surgery. Perioperative complications account for 22% of preventable deaths, 2.4 million additional hospital stays, and $9.3 billion in extra healthcare spending, reported the investigators.

The researchers conducted a meta-analysis to evaluate the effects of acute statin treatment in statin-naive patients on perioperative death, MI, atrial fibrillation, and length of hospital and intensive care unit (ICU) stay in randomized controlled studies. Two investigators independently selected eligible studies from original research published studying the effects of statin use on perioperative outcomes of interest. Researchers identified 15 randomized controlled trials involving 2292 patients. Eligible trials ranged from 40 to 533 patients and evaluated a variety of statin doses and regimens. Patients started statin therapy anywhere from 2 to 37 days before surgery and lasting 3 to 67 days. No patients were prescribed statin therapy before randomization in any study. The 15 trials were categorized as cardiac surgery (n=11), vascular surgery (n=2), and noncardiac surgery (n=2).

Of the 15 trials, 10 studies reported rates of MI (n=2077). The incidence of perioperative MI in statin-treated patients was 4.5% (47 of 1041 patients), compared with 8.9% in controls (92 of 1036)—a significant risk reduction (relative risk [RR], 0.53; 95% confidence interval [CI], 0.38-0.74). The effect was seen in both cardiac and noncardiac patients.

Whereas 10 of the 15 studies included inpatient or 30-day mortality as an outcome of interest, death occurred in only 5 studies. As a result, only data from these studies (n=1436) were analyzed for this outcome. Statin treatment was associated with a 2.2% incidence of death (16 of 719 patients) versus 3.7% in controls (26 of 711 patients). The data showed this effect was not significant (RR, 0.62; 95% CI, 0.34-1.14; P=.13).

Nine of the 15 trials (all involving cardiac surgery) reported atrial fibrillation complications (n=933). Based on the results, 19.9% (93 of 467) of statin recipients experienced atrial fibrillation, compared with 36.3% (169 of 466) of control patients (RR, 0.56; 95% CI, 0.45-0.69; number needed to treat 6).

Finally, 12 of the 15 trials reported mean hospital length of stay in days (n=2105). Eight of these 12 studies involved only cardiac surgery. Statin treatment reduced the mean length of hospital stay (standardized mean difference, −0.32; 95% CI, −0.53 to −0.11) but had no effect on length of ICU stay (standardized mean difference, −0.08; 95% CI, −0.25 to 0.10). Nine of the 15 studies reported ICU length of stay.

The researchers noted that exclusion of studies involving cardiac surgery removed 11 of the 15 eligible studies and statistically negated the reduction found in hospital length of stay.

The researchers cited 3 study limitations. The results could have been influenced by publication bias. Most of the studies eligible for analysis included patients undergoing cardiac surgery because few randomized trials of patients undergoing noncardiac surgery exist. The impact of statin treatment on hospital and ICU length of stay was limited owing to the heterogeneity of treatment effected noted in the results.

Because treatment with perioperative statins in cardiac and noncardiac surgery significantly lowered the risk of MI and atrial fibrillation and decreased mean length of hospital stay, the investigators recommended that “perioperative practice and guidelines should be modified to incorporate greater use of statins in patients undergoing surgery.”