Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery:: a meta-analysis of over 30,000 patients
Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery:: a meta-analysis of over 30,000 patients
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DOI：
10.1093/eurheartj/ehn198
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发表时间：
2008-06-01
影响因子：
39.3
通讯作者：
Wahlers, Thorsten
中科院分区：
文献类型：
--
作者：
Liakopoulos, Oliver J.;Choi, Yeong-Hoon;Wahlers, Thorsten
目的：确定术前使用他汀类药物预防心脏手术患者术后不良结局的证据强度。方法和结果：在主要数据库中进行文献检索后，确定了19项研究[3项RCT（随机前瞻性临床试验），16项观察性研究]，报告了31725例心脏手术患者的结局，（n = 17 201; 54%）或无（n = 14 524; 46%）术前他汀类药物治疗。分析的结局包括早期全因死亡率（30天死亡率）、心肌梗死（MI）、房颤（AF）、卒中和肾衰竭。使用固定或随机效应模型报告比值比（OR）和95%置信区间（95%CI），并评估发表偏倚。术前他汀类药物治疗可使早期全因死亡率的绝对风险降低1.5%（2.2 vs. 3.7%; P < 0.0001），比值比降低43%（OR 0.57; 95%CI：0.49-0.67）。显著减少他汀类药物预治疗组房颤发生率明显高于他汀类药物预治疗组（P < 0.01）（24.9 vs. 29.3%; OR 0.67，95%CI：0.51-0.88），卒中（2.1 vs. 2.9%，OR 0.74，95%CI：0.60-0.91），但不适用于MI（OR 1.11; 95%CI：0.93-1.33）或肾衰竭（OR 0.78，95%CI：0.46-1.31）。漏斗图和Egger的回归分析（P = 0.60）排除了相关的出版bias.Conclusion我们的荟萃分析提供的证据表明，术前他汀类药物治疗心脏手术患者术后早期不良结局产生实质性的临床效益，但强调需要RCT试验。
Aims To determine the strength of evidence for preoperative statin use for prevention of adverse postoperative outcomes in patients undergoing cardiac surgery.Methods and results After literature search in major databases, 19 studies were identified [three RCT (randomized prospective clinical trials), 16 observational] that reported outcomes of 31 725 cardiac surgery patients with (n = 17 201; 54%) or without (n = 14 524; 46%) preoperative statin therapy. Outcomes that were analysed included early all-cause mortality (30-day mortality), myocardial infarction (MI), atrial fibrillation (AF), 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. Preoperative statin therapy resulted in a 1.5% absolute risk reduction (2.2 vs. 3.7%; P < 0.0001) and 43% odds reduction for early all-cause mortality (OR 0.57; 95%CI: 0.49-0.67). A significant reduction (P < 0.01) in statin pretreated patients was also observed for AF (24.9 vs. 29.3%; OR 0.67, 95%CI: 0.51-0.88), stroke (2.1 vs. 2.9%, OR 0.74, 95%CI: 0.60-0.91), but not for MI (OR 1.11; 95%CI: 0.93-1.33) or renal failure (OR 0.78, 95%CI: 0.46-1.31). Funnel plot and Egger's regression analysis (P = 0.60) excluded relevant publication bias.Conclusion Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials.