The quality of evidence is downgraded by study limitations (unclear allocation concealment and failure to adhere to the intention-to-treat principle).
Starting statin therapy preoperatively is recommended for patients referred to coronary artery bypass grafting surgery.The recommendation is strong because potential benefits of the intervention clearly exceed plausible harms.
A Cochrane review [withdrawn from publication] included 17 studies with a total of 2 138 subjects undergoing cardiac surgical procedures (mainly coronary artery bypass grafting, CABG). Atorvastatin was used in 11 studies, simvastatin in 3 studies, fluvastatin, rosuvastatin, and pravastatin in one study, respectively. A comparison with placebo was carried out in 10 studies, whereas 7 studies compared patients receiving preoperative statin treatment to a statin naive control group without placebo therapy. The duration of preoperative intake of statin varied from the evening before surgery to 4 weeks before the operation.
Statin pre-treatment before surgery reduced the incidence of post-operative atrial fibrillation (AF), but failed to influence short-term mortality, post-operative stroke, myocardial infarction (MI), or renal failure. Statin therapy was associated with a shorter length of stay of patients on the intensive care unit (ICU) and in-hospital; for length of hospital stay, significant heterogeneity was observed among studies. No major or minor perioperative statin side-effects were reported from trials investigating this safety endpoint.
| Outcome | Number of participants (studies) | Mean follow-up | Asssumed risk (control) | Corresponding risk (statin) | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Mortality | 300 (2 studies) | 11 days | 13 per 1000 | 24 per 1000 (5 to 104) | OR 1.80 (0.38 to 8.54) |
| Myocardial infarction | 901 (7 studies) | 19 days | 31 per 1000 | 15 per 1000 (7 to 35) | OR 0.48 (0.21 to 1.13) |
| Atrial fibrillation | 1 765 (12 studies) | 20 days | 322 per 1000 | 204 per 1000 (170 to 242) | OR 0.54 (0.43 to 0.67) |
| Stroke | 264 (2 studies) | 15 days | 23 per 1000 | 16 per 1000 (3 to 78) | OR 0.7 (0.14 to 3.63) |
| Renal failure | 467 (5 studies) | 9 days | 125 per 1000 | 75 per 1000 (41 to 136) | OR 0.57 (0.3 to 1.1) |
| Length of stay in hospital | 1 137 (11 studies) | 16 days | Mean length of stay in hospital in the intervention groups was 0.41 days lower (0.73 to 0.08 lower) | ||
| Length of stay on ICU | 721 (9 studies) | 18.5 hours | Mean length of stay on ICU in the intervention groups was 2.54 hours lower (4.72 to 0.36 lower) | ||
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