Statin use and clinical outcomes after cardiac surgery: a meta-analysis of over 90.000 patients

Objective: Preoperative statin therapy reduces adverse postoperative outcomes in patients undergoing non-cardiac surgery through lipid-independent actions, but data from large RCT cardiac surgery trials is lacking. We sought to determine the strength of evidence for preoperative statin use on adverse postoperative outcomes in cardiac surgery patients.

Methods: A meta-analysis of randomized (RCT) and observational trials reporting the effects of preoperative statin therapy on major clinical outcomes after cardiac surgery was performed. Analyzed outcomes included early all-cause mortality, myocardial infarction, atrial fibrillation, stroke and renal failure. Odds ratio (OR) with 95% confidence intervals (95% CI) were reported using fixed or random effect models and publication bias was assessed.

Results: After literature search in major databases, 2371 studies were retrieved and screened, and 54 studies identified (12 RCT, 42 observational) that reported outcomes of 91.491 cardiac surgery patients with (n=46614; 51%) or without (n=44877; 49%) preoperative statin therapy. Statin use resulted in a 0.9% absolute risk (2.6% vs. 3.5%) and odds reduction for early all-cause mortality (OR 0.69; 95% CI 0.59–0.81; p<0.0001). A significant reduction (p<0.01) in statin pretreated patients was also observed for atrial fibrillation (OR 0.69; 95% CI 0.59–0.80), new onset atrial fibrillation (OR 0.68; 95% CI 0.54–0.85), stroke (OR 0.83; 95% CI 0.74–093), but not for myocardial infarction (OR 1.05; 95% CI 0.91–1.21) or renal failure (OR 1.03; 95% CI 0.89–1.19).

Conclusion: Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients and underlines the need for large RCT trials.