Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trialsReport as inadecuate




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Critical Care

, 20:395

First Online: 05 December 2016Received: 30 August 2016Accepted: 07 November 2016DOI: 10.1186-s13054-016-1560-6

Cite this article as: Putzu, A., Capelli, B., Belletti, A. et al. Crit Care 2016 20: 395. doi:10.1186-s13054-016-1560-6

Abstract

BackgroundSeveral studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials RCTs show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients.

MethodsElectronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery. Postoperative outcomes were acute kidney injury, atrial fibrillation, myocardial infarction, stroke, infections, and mortality. We calculated odds ratios ORs and 95% confidence intervals CIs using fixed-effects meta-analyses. Primary analysis was restricted to trials with low risk of bias according to Cochrane methodology, and sensitivity analyses examined whether the risk of bias of included studies was associated with different results. We performed trial sequential analysis TSA to test the strength of the results.

ResultsWe included data from 23 RCTs involving 5102 patients. Meta-analysis of trials with low risk of bias showed that statin therapy was associated with an increase in acute kidney injury 314 of 1318 23.82% with statins versus 262 of 1319 19.86% with placebo; OR 1.26 95%CI 1.05 to 1.52; p = 0.01; these results were supported by TSA. No difference in postoperative atrial fibrillation, myocardial infarction, stroke, infections, or mortality was present. On sensitivity analysis, statin therapy was associated with a slight increase in hospital mortality. Meta-analysis including also trials with high or unclear risk of bias showed no beneficial effects of statin therapy on any postoperative outcomes.

ConclusionsThere is no evidence that statin therapy in the days prior to cardiac surgery is beneficial for patients’ outcomes. Particularly, statins are not protective against postoperative atrial fibrillation, myocardial infarction, stroke, or infections. Statins are associated with a possible increased risk of acute kidney injury and a detrimental effect on hospital survival could not be excluded. Future RCTs should further evaluate the safety profile of this therapy in relation to patients’ outcomes and assess the more appropriate time point for discontinuation of statins before cardiac surgery.

KeywordsCardiac surgery Statins Acute kidney injury Atrial fibrillation Myocardial infarction Stroke Mortality Cardiac anesthesia Intensive care AbbreviationsAFatrial fibrillation

AKIacute kidney injury

CABGcoronary artery bypass grafting

CIconfidence interval

MImyocardial infarction

NNHnumber needed to harm

NNTnumber needed to treat

ORodds ratio

PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses

RCTrandomized controlled trial

RRIrelative risk increase

RRRrelative risk reduction

TSAtrials sequential analysis

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-016-1560-6 contains supplementary material, which is available to authorized users.

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Author: Alessandro Putzu - Bruno Capelli - Alessandro Belletti - Tiziano Cassina - Enrico Ferrari - Michele Gallo - Gabriele Casso

Source: https://link.springer.com/



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