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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 Luglio;81(7):723-33
Preoperative use of statins does not improve outcomes and development of acute renal failure after cardiac surgery. A propensity score analysis of ARIAM-Andalucía database
Curiel-Balsera E. 1, Muñoz-Bono J. 1, Olea-Jimenez V. 1, Sanchez-Cantalejo E. 2, 3, 4, Sanchez-Rodriguez A. C. 5, García-Delgado M. 6, Arias-Verdú M. D. 1, Rivera-Fernandez R. 7 ✉
1 Carlos Haya Regional University Hospital, Malaga, Spain;
2 Andalusian School of Public Health, Granada, Spain;
3 CIBER de Epidemiología y Salud Publica (CIBERESP), Madrid, Spain;
4 Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain;
5 Puerta del Mar Hospital, Cadiz, Spain;
6 Virgen de las Nieves Hospital, Granada, Spain;
7 Serrania Hospital, Ronda, Malaga, Spain
BACKGROUND: Statin use prior to cardiac surgery has been reported to improve outcomes in the postoperative period because of other effects apart from decreasing lipid levels. Objective of the study was to analyse mortality and acute renal failure (ARF) during the cardiac surgery postoperative period in patients treated with or without statins.
METHODS: This prospective cohort study comprised adult patients who underwent cardiac surgery at 11 institutions in the Andalusian community from March 2008 to July 2012 included in the ARIAM adult cardiac surgery project. We performed a first analysis in the whole cohort and in a second analysis statin users prior to surgery were pair matched with non-users according to their propensity score based on demographics, comorbidities, medication and surgical data. We analysed differences in outcomes, ARF, need for renal replacement therapy (RRT) and a composite end point with mortality or major morbidity in both groups.
RESULTS: The study included 7276 patients, of whom 3749 were treated with statins. Overall, hospital mortality was 10.1%, 10.5% developed ARF and 2.5% required RRT. In the whole non-matched cohort, statins were associated with lower hospital mortality (OR 0.79; 95% CI, 0.67-0.93) and less ARF (OR 0.79; 95% CI, 0.68-0.93). However, after propensity score analysis in the matched cohort of 3056 patients (1528 in each group), statin use was not consistently associated with less ARF (OR 0.94; 95% CI, 0.74-1.19), hospital mortality (OR 0.83; 95% CI, 0.68-1.1) or composite outcome (OR 0.857; 95% CI, 0.723-1.015).
CONCLUSION: Despite better outcomes for the statin users in the whole cohort, the matched analysis showed that statin use before cardiac surgery was not associated with a lower risk of ARF. Nor was presurgery statin use associated with lower hospital mortality.