El pretratamiento con atorvastatina disminuye los niveles de marcadores tempranos de isquemia miocárdica después de cirugía coronaria. Estudio observacional |
Atorvastatin pretreatment diminishes the levels of myocardial ischemia markers early after CABG operation: an observational study.
Ege E, Dereli Y, Kurban S, Sarigül A.
Selçuk University, Meram Medical School, Department of Cardiovascular Surgery, Konya, Turkey.
J Cardiothorac Surg. 2010 Aug 13;5:60.
Abstract
BACKGROUND: Statin pretreatment has been associated with a decrease in myocardial ischemia markers after various procedures and cardiovascular events. This study examined the potential beneficial effects of preoperative atorvastatin treatment among patients undergoing on-pump CABG operation. METHODS: Twenty patients that had received atorvastatin treatment for at least 15 days prior to the operation and 20 patients who had not received any antihyperlipidemic agent prior to surgery were included in this study. CK-MB and troponin I levels were measured at baseline and 24 hours after the operation. Perioperative variables were also recorded. RESULTS: Twenty-four hours after the operation, troponin I and CK-MB levels were significantly lower in the atorvastatin group: for CK-MB levels, 12.9 +/- 4.3 versus 18.7 +/- 7.4 ng/ml, p = 0.004; for troponin I levels, 1.7 +/- 0.3 versus 2.7 +/- 0.7 ng/ml, p < 0.001. In addition, atorvastatin use was associated with a decrease in the duration of ICU stay. CONCLUSIONS: Preoperative atorvastatin treatment results in significant reductions in the levels of myocardial injury markers early after on-pump CABG operation, suggesting a reduction in perioperative ischemia in this group of patients. Further studies are needed to elucidate the mechanisms of these potential benefits of statin pretreatment
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| Impacto de la terapia preoperatoria con estatinas sobre la evolución postoperatoria adversa en pacientes con cirugía vascular |
Impact of Preoperative Statin Therapy on Adverse Postoperative Outcomes in Patients Undergoing Vascular Surgery
Le Manach, Yannick M.D; Ibanez Esteves, Cristina M.D.; Bertrand, Michelle M.D.; Goarin, Jean Pierre M.D.; Fléron, Marie-Hélène M.D.; Coriat, Pierre M.D.; Koskas, Fabien M.D., Ph.D.; Riou, Bruno M.D., Ph.D.; Landais, Paul M.D., Ph.D.
Anesthesiology January 2011,14 - Issue 1 - pp 98-104. doi:10.1097/ALN.0b013e31820254a6
Abstract
Background: Chronic statin therapy is associated with reduced postoperative mortality. Renal and cardiovascular benefits have been described, but the effect of chronic statin therapy on postoperative adverse events has not yet been explored. Methods: In this observational study involving 1,674 patients undergoing aortic reconstruction, we prospectively assessed chronic statin therapy compared with no statin therapy, with regard to serious outcomes, by propensity score and multivariable methods. Results: In propensity-adjusted multivariable logistic regression (c-index: 0.83), statins were associated with an almost threefold reduction in the risk of death in patients undergoing major vascular surgery (odds ratio: 0.40; 95% CI: 0.28-0.59) and an almost twofold reduction in the risk of postoperative myocardial infarction (odds ratio: 0.52; 95% CI: 0.38-0.71). Likewise, the use of chronic statin therapy was associated with a reduced risk of postoperative stroke and renal failure. Statins did not significantly reduce the risk of pneumonia, multiple organ dysfunction syndrome, and surgical complications; however, in the case of postoperative multiple organ dysfunction syndrome (odds ratio: 0.34; 95% CI: 0.12-0.94) and surgical complications (odds ratio: 0.39; 95% CI: 0.17-0.86), reduced mortality was observed. Conclusions: Chronic statin therapy was associated with a reduction in all cardiac and vascular outcomes after major vascular surgery. Furthermore, in major adverse events, such as multiple organ dysfunction syndrome and surgical complications, statins were also associated with decreased mortality.
Enlace para leer el artículo completo;
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| Impacto de la terapia preoperatoria con estatinas sobre la evoluión postoperatoria de pacientes con cirugía cardiaca: meta análisis de más de 30,000 pacientes |
Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients.
Liakopoulos OJ, Choi YH, Haldenwang PL, Strauch J, Wittwer T, Dörge H, Stamm C, Wassmer G, Wahlers T.
Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany.
Eur Heart J. 2008 Jun;29(12):1548-59. Epub 2008 May 27
Abstract
AIMS: To determine the strength of evidence for preoperative statin use for prevention of adverse postoperative outcomes in patients undergoing cardiac surgery. METHODS AND RESULTS: After literature search in major databases, 19 studies were identified [three RCT (randomized prospective clinical trials), 16 observational] that reported outcomes of 31 725 cardiac surgery patients with (n = 17 201; 54%) or without (n = 14 524; 46%) preoperative statin therapy. Outcomes that were analysed included early all-cause mortality (30-day mortality), myocardial infarction (MI), atrial fibrillation (AF), stroke and renal failure. Odds ratio (OR) with 95% confidence intervals (95%CI) were reported using fixed or random effect models and publication bias was assessed. Preoperative statin therapy resulted in a 1.5% absolute risk reduction (2.2 vs. 3.7%; P < 0.0001) and 43% odds reduction for early all-cause mortality (OR 0.57; 95%CI: 0.49-0.67). A significant reduction (P < 0.01) in statin pretreated patients was also observed for AF (24.9 vs. 29.3%; OR 0.67, 95%CI: 0.51-0.88), stroke (2.1 vs. 2.9%, OR 0.74, 95%CI: 0.60-0.91), but not for MI (OR 1.11; 95%CI: 0.93-1.33) or renal failure (OR 0.78, 95%CI: 0.46-1.31). Funnel plot and Egger's regression analysis (P = 0.60) excluded relevant publication bias. CONCLUSION: Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials. Enlace para leer el artículo completo: |
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