Midterm benefits of preoperative statin therapy in patients undergoing isolated valve surgery

Muthiah Vaduganathan, Neil J. Stone, Adin Cristian Andrei, Richard Lee, Preeti Kansal, Robert A. Silverberg, Robert O. Bonow, Patrick M. McCarthy

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Recent data have suggested that statins are associated with reduced early mortality and cardiovascular events after valvular heart surgery. The midterm effects of preoperative statin therapy in the setting of valvular heart surgery are presently unclear. Methods: All patients (n = 2,120) who underwent a valvular procedure between April 2004 and April 2010 were identified. Patients undergoing concomitant coronary artery bypass graft surgery were excluded. Two patient groups were studied: those who received preoperative statin therapy (n = 663; 31.3%) and those who did not (n = 1,457; 68.7%). Propensity score matching resulted in 381 matched pairs, thus addressing baseline risk imbalances. Thirty-day mortality, readmission rates, postoperative complications, and length of stay were analyzed. Late survival was ascertained by the Social Security Death Index. Results: In the matched group, 30-day mortality was 1.3% (5 of 381) for statin-treated patients versus 4.2% (16 of 381) for statin-untreated patients (p = 0.03). After a mean follow-up of 33 ± 23 months, statin therapy was associated with significantly reduced mortality (hazard ratio 0.63, 95% confidence interval: 0.43 to 0.93, p = 0.019), independent of known cardiac risk factors. Weighted log rank tests revealed that the mortality difference between the two cohorts occurred early after surgery (p = 0.015). Statin users were less likely to be readmitted to the intensive care unit (3.4% versus 8.1%, p = 0.01). There were no other significant differences between the two groups in terms of postoperative complications and length of stay. Conclusions: Preoperative statin administration is associated with early reductions in mortality among patients undergoing isolated valvular heart surgery, leading to improved late survival. Future prospective analyses are warranted to optimize statin therapy in this patient population.

Original languageEnglish (US)
Pages (from-to)1881-1887
Number of pages7
JournalAnnals of Thoracic Surgery
Volume93
Issue number6
DOIs
StatePublished - Jun 1 2012

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Mortality
Thoracic Surgery
Therapeutics
Length of Stay
Propensity Score
Survival
Social Security
Coronary Artery Bypass
Intensive Care Units
Research Design
Confidence Intervals
Transplants

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Vaduganathan, M., Stone, N. J., Andrei, A. C., Lee, R., Kansal, P., Silverberg, R. A., ... McCarthy, P. M. (2012). Midterm benefits of preoperative statin therapy in patients undergoing isolated valve surgery. Annals of Thoracic Surgery, 93(6), 1881-1887. https://doi.org/10.1016/j.athoracsur.2012.02.091

Midterm benefits of preoperative statin therapy in patients undergoing isolated valve surgery. / Vaduganathan, Muthiah; Stone, Neil J.; Andrei, Adin Cristian; Lee, Richard; Kansal, Preeti; Silverberg, Robert A.; Bonow, Robert O.; McCarthy, Patrick M.

In: Annals of Thoracic Surgery, Vol. 93, No. 6, 01.06.2012, p. 1881-1887.

Research output: Contribution to journalArticle

Vaduganathan, M, Stone, NJ, Andrei, AC, Lee, R, Kansal, P, Silverberg, RA, Bonow, RO & McCarthy, PM 2012, 'Midterm benefits of preoperative statin therapy in patients undergoing isolated valve surgery', Annals of Thoracic Surgery, vol. 93, no. 6, pp. 1881-1887. https://doi.org/10.1016/j.athoracsur.2012.02.091
Vaduganathan, Muthiah ; Stone, Neil J. ; Andrei, Adin Cristian ; Lee, Richard ; Kansal, Preeti ; Silverberg, Robert A. ; Bonow, Robert O. ; McCarthy, Patrick M. / Midterm benefits of preoperative statin therapy in patients undergoing isolated valve surgery. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 6. pp. 1881-1887.
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abstract = "Background: Recent data have suggested that statins are associated with reduced early mortality and cardiovascular events after valvular heart surgery. The midterm effects of preoperative statin therapy in the setting of valvular heart surgery are presently unclear. Methods: All patients (n = 2,120) who underwent a valvular procedure between April 2004 and April 2010 were identified. Patients undergoing concomitant coronary artery bypass graft surgery were excluded. Two patient groups were studied: those who received preoperative statin therapy (n = 663; 31.3{\%}) and those who did not (n = 1,457; 68.7{\%}). Propensity score matching resulted in 381 matched pairs, thus addressing baseline risk imbalances. Thirty-day mortality, readmission rates, postoperative complications, and length of stay were analyzed. Late survival was ascertained by the Social Security Death Index. Results: In the matched group, 30-day mortality was 1.3{\%} (5 of 381) for statin-treated patients versus 4.2{\%} (16 of 381) for statin-untreated patients (p = 0.03). After a mean follow-up of 33 ± 23 months, statin therapy was associated with significantly reduced mortality (hazard ratio 0.63, 95{\%} confidence interval: 0.43 to 0.93, p = 0.019), independent of known cardiac risk factors. Weighted log rank tests revealed that the mortality difference between the two cohorts occurred early after surgery (p = 0.015). Statin users were less likely to be readmitted to the intensive care unit (3.4{\%} versus 8.1{\%}, p = 0.01). There were no other significant differences between the two groups in terms of postoperative complications and length of stay. Conclusions: Preoperative statin administration is associated with early reductions in mortality among patients undergoing isolated valvular heart surgery, leading to improved late survival. Future prospective analyses are warranted to optimize statin therapy in this patient population.",
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AU - Vaduganathan, Muthiah

AU - Stone, Neil J.

AU - Andrei, Adin Cristian

AU - Lee, Richard

AU - Kansal, Preeti

AU - Silverberg, Robert A.

AU - Bonow, Robert O.

AU - McCarthy, Patrick M.

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N2 - Background: Recent data have suggested that statins are associated with reduced early mortality and cardiovascular events after valvular heart surgery. The midterm effects of preoperative statin therapy in the setting of valvular heart surgery are presently unclear. Methods: All patients (n = 2,120) who underwent a valvular procedure between April 2004 and April 2010 were identified. Patients undergoing concomitant coronary artery bypass graft surgery were excluded. Two patient groups were studied: those who received preoperative statin therapy (n = 663; 31.3%) and those who did not (n = 1,457; 68.7%). Propensity score matching resulted in 381 matched pairs, thus addressing baseline risk imbalances. Thirty-day mortality, readmission rates, postoperative complications, and length of stay were analyzed. Late survival was ascertained by the Social Security Death Index. Results: In the matched group, 30-day mortality was 1.3% (5 of 381) for statin-treated patients versus 4.2% (16 of 381) for statin-untreated patients (p = 0.03). After a mean follow-up of 33 ± 23 months, statin therapy was associated with significantly reduced mortality (hazard ratio 0.63, 95% confidence interval: 0.43 to 0.93, p = 0.019), independent of known cardiac risk factors. Weighted log rank tests revealed that the mortality difference between the two cohorts occurred early after surgery (p = 0.015). Statin users were less likely to be readmitted to the intensive care unit (3.4% versus 8.1%, p = 0.01). There were no other significant differences between the two groups in terms of postoperative complications and length of stay. Conclusions: Preoperative statin administration is associated with early reductions in mortality among patients undergoing isolated valvular heart surgery, leading to improved late survival. Future prospective analyses are warranted to optimize statin therapy in this patient population.

AB - Background: Recent data have suggested that statins are associated with reduced early mortality and cardiovascular events after valvular heart surgery. The midterm effects of preoperative statin therapy in the setting of valvular heart surgery are presently unclear. Methods: All patients (n = 2,120) who underwent a valvular procedure between April 2004 and April 2010 were identified. Patients undergoing concomitant coronary artery bypass graft surgery were excluded. Two patient groups were studied: those who received preoperative statin therapy (n = 663; 31.3%) and those who did not (n = 1,457; 68.7%). Propensity score matching resulted in 381 matched pairs, thus addressing baseline risk imbalances. Thirty-day mortality, readmission rates, postoperative complications, and length of stay were analyzed. Late survival was ascertained by the Social Security Death Index. Results: In the matched group, 30-day mortality was 1.3% (5 of 381) for statin-treated patients versus 4.2% (16 of 381) for statin-untreated patients (p = 0.03). After a mean follow-up of 33 ± 23 months, statin therapy was associated with significantly reduced mortality (hazard ratio 0.63, 95% confidence interval: 0.43 to 0.93, p = 0.019), independent of known cardiac risk factors. Weighted log rank tests revealed that the mortality difference between the two cohorts occurred early after surgery (p = 0.015). Statin users were less likely to be readmitted to the intensive care unit (3.4% versus 8.1%, p = 0.01). There were no other significant differences between the two groups in terms of postoperative complications and length of stay. Conclusions: Preoperative statin administration is associated with early reductions in mortality among patients undergoing isolated valvular heart surgery, leading to improved late survival. Future prospective analyses are warranted to optimize statin therapy in this patient population.

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