Preoperative statin therapy in cardiac surgery: a meta-analysis of 90 000 patients
Preoperative statin therapy in cardiac surgery: a meta-analysis of 90 000 patients
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DOI：
10.1093/ejcts/ezt181
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发表时间：
2014-01-01
影响因子：
3.4
通讯作者：
Wahlers, Thorsten
中科院分区：
文献类型：
--
作者：
Kuhn, Elmar W.;Liakopoulos, Oliver J.;Wahlers, Thorsten
本系统文献综述和荟萃分析的目的是确定术前他汀类药物可减少心脏手术患者术后不良结局的证据强度。在在线数据库中检索了随机对照（RCT）和观察性试验，报告了术前他汀类药物治疗对心脏手术后主要不良临床结果的影响。使用先验定义的标准分析结果包括早期全因死亡率、心肌梗死、心房颤动（AF）、中风和肾衰竭。使用固定或随机效应模型计算效果估计值并以优势比 (OR) 和 95% 置信区间 (95% CI) 给出。对所有主要数据库进行文献检索，检索到 2371 项研究。筛选后，共确定了 54 项试验（12 项随机对照试验，42 项观察性试验），报告了 91 491 名心脏手术患者接受（n = 46 614；51%）或未接受（n = 44 877；49%）术前他汀类药物治疗的患者的结果。术前使用他汀类药物导致早期全因死亡率的绝对风险降低 0.9%（2.6% vs 3.5%），并使早期全因死亡率降低 31%（OR 0.69；95% CI 0.59-0.81；P < 0.0001）。此外，术前他汀类药物治疗与术后终点 AF（OR 0.71；95% CI 0.61-0.82）、新发 AF（OR 0.68；95% CI 0.54-0.85）、卒中（OR 0.83；95% CI 0.74-0.93）、继续强化治疗的显着减少相关（P < 0.01）。监护病房（加权平均差 [WMD] -0.14；95% CI -0.23 至 -0.03；P < 0.01）和住院时间（WMD -0.57；95% CI -0.76 至 -0.38；P < 0.01）。在心肌梗塞或肾衰竭方面，各组之间没有发现统计学差异。总之，当前的系统评价强化了以下证据：术前他汀类药物治疗可以为心脏手术患者的早期术后结局带来显着的临床益处。
The objective of this systematic literature review with meta-analysis was to determine the strength of evidence for a preoperative statin on the reduction of adverse postoperative outcomes in patients undergoing cardiac surgery. Randomized controlled (RCT) and observational trials were searched in online databases that reported about the effects of preoperative statin therapy on major adverse clinical outcomes after cardiac surgery. Analysed outcomes included early all-cause mortality, myocardial infarction, atrial fibrillation (AF), stroke and renal failure using a priori-defined criteria. Effect estimates were calculated and are given as odds ratio (OR) with 95% confidence intervals (95% CI) using fixed-or random-effect models. Literature search of all major databases retrieved 2371 studies. After screening, a total of 54 trials were identified (12 RCT, 42 observational) that reported outcomes of 91 491 cardiac surgery patients with (n = 46 614; 51%) or without (n = 44 877; 49%) preoperative statin therapy. Preoperative statin use resulted in a 0.9% absolute risk (2.6 vs 3.5%) and a 31% odds reduction for early all-cause mortality (OR 0.69; 95% CI 0.59-0.81; P < 0.0001). In addition, statin treatment before surgery was associated with a substantial reduction (P < 0.01) in the postoperative end-points AF (OR 0.71; 95% CI 0.61-0.82), new-onset AF (OR 0.68; 95% CI 0.54-0.85), stroke (OR 0.83; 95% CI 0.74-0.93), stay on intensive care unit (weighted mean difference [WMD] -0.14; 95% CI -0.23 to -0.03; P < 0.01) and in-hospital stay (WMD -0.57; 95% CI -0.76 to -0.38; P < 0.01). No statistical differences were found between groups with regard to myocardial infarction or renal failure. In conclusion, the current systematic review strengthens the evidence that preoperative statin therapy extends substantial clinical benefit to early postoperative outcomes in cardiac surgery patients.