Continuative statin therapy after percutaneous coronary intervention improves outcome in coronary bypass surgery: A propensity score analysis of 2501 patients

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 5; pp. 1876 - 1883
• Main Authors: Mannacio, Vito, MD, Meier, Pascal, MD, Antignano, Anita, MD, Mottola, Michele, MD, Di Tommaso, Luigi, MD, Musumeci, Francesco, MD, Vosa, Carlo, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2014
• Subjects: Aged; Cardiothoracic Surgery; Chi-Square Distribution; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Drug Administration Schedule; Elective Surgical Procedures; Female; Hospital Mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Italy; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Postoperative Complications - mortality; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Italy; major adverse cardiac events; 23; NO; nitric oxide; OR; CI; myocardial infarction; odds ratio; percutaneous coronary intervention; CPB; MACE; PCI; cardiopulmonary bypass; confidence interval; CABG; MI; coronary artery bypass grafting
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.02.045

Objectives A history of percutaneous coronary intervention increases the risk of death and complications of coronary artery bypass grafting. This retrospective multicenter study evaluated the impact of continuative use of statin on postoperative outcomes when subsequent elective coronary artery bypass grafting is required after percutaneous coronary intervention. Methods Among 14,575 patients who underwent isolated first-time coronary artery bypass grafting between January 2000 and December 2010, 2501 who had previous percutaneous coronary intervention with stenting and fulfilled inclusion criteria were enrolled. Continuative statin therapy was used in 1528 patients and not used in 973 patients. Logistic multiple regression and propensity score analyses were used to assess the risk-adjusted impact of statin therapy on in-hospital mortality and major adverse cardiac events. The Cox proportional hazards model was constructed to assess the effect of continuative statin therapy on 24-month outcome. Results At multivariate analysis, age more than 70 years, 3-vessel or 2-vessel plus left main coronary disease, multivessel percutaneous coronary intervention, ejection fraction 0.40 or less, diabetes mellitus, and logistic European System for Cardiac Operative Risk Evaluation 5 or greater were independent predictors of hospital mortality and major adverse cardiac events. After propensity score matching, conditional logistic regression analysis demonstrated that continuative statin therapy before coronary artery bypass grafting reduced the risk for hospital and 2-year mortality (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.12-0. 57; P  = .004 and OR, 0.6; 95% CI, 0.36-0.96; P  = .04, respectively) and major adverse cardiac events (OR, 0.31; 95% CI, 0.18-0.78; P  = .003 and OR, 0.5; 95% CI, 0.34-0.76; P  = .006, respectively). Conclusions Long-term statin treatment after percutaneous coronary intervention improves early and midterm outcome when surgical revascularization will be required.