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J Thorac Cardiovasc Surg. 2014 Nov;148(5):1876-83. doi: 10.1016/j.jtcvs.2014.02.045. Epub 2014 Feb 20.

Continuative statin therapy after percutaneous coronary intervention improves outcome in coronary bypass surgery: a propensity score analysis of 2501 patients.

Author information

  • 1Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy. Electronic address: vitomannacio2@libero.it.
  • 2Divisions of Cardiology and Cardiac Surgery, Yale Medical School, New Haven, Conn; Cardiology, University College London Hospital, London, United Kingdom.
  • 3Department of Cardiology, Azienda Ospedaliera Santobono-Pausillipon, Naples, Italy.
  • 4Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
  • 5Department of Cardiac Surgery, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.

Abstract

OBJECTIVES:

A history of percutaneous coronary intervention increases the risk of death and complications of coronary artery bypass grafting. This retrospective multicenter study evaluated the impact of continuative use of statin on postoperative outcomes when subsequent elective coronary artery bypass grafting is required after percutaneous coronary intervention.

METHODS:

Among 14,575 patients who underwent isolated first-time coronary artery bypass grafting between January 2000 and December 2010, 2501 who had previous percutaneous coronary intervention with stenting and fulfilled inclusion criteria were enrolled. Continuative statin therapy was used in 1528 patients and not used in 973 patients. Logistic multiple regression and propensity score analyses were used to assess the risk-adjusted impact of statin therapy on in-hospital mortality and major adverse cardiac events. The Cox proportional hazards model was constructed to assess the effect of continuative statin therapy on 24-month outcome.

RESULTS:

At multivariate analysis, age more than 70 years, 3-vessel or 2-vessel plus left main coronary disease, multivessel percutaneous coronary intervention, ejection fraction 0.40 or less, diabetes mellitus, and logistic European System for Cardiac Operative Risk Evaluation 5 or greater were independent predictors of hospital mortality and major adverse cardiac events. After propensity score matching, conditional logistic regression analysis demonstrated that continuative statin therapy before coronary artery bypass grafting reduced the risk for hospital and 2-year mortality (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.12-0. 57; P=.004 and OR, 0.6; 95% CI, 0.36-0.96; P=.04, respectively) and major adverse cardiac events (OR, 0.31; 95% CI, 0.18-0.78; P=.003 and OR, 0.5; 95% CI, 0.34-0.76; P=.006, respectively).

CONCLUSIONS:

Long-term statin treatment after percutaneous coronary intervention improves early and midterm outcome when surgical revascularization will be required.

Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

PMID:
24667027
[PubMed - indexed for MEDLINE]
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