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Title: Preoperative Statins Offer Lower Mortality, Less Need for Haemodialysis After Coronary Artery Bypass Graft: Presented at ASA
URL: http://www.pslgroup.com/dg/23149E.htm
Doctor's Guide
October 23, 2008

By Deborah Brauser

ORLANDO, Fla -- October 23, 2008 -- Preoperative administration of statins can lower the risks of perioperative mortality and the need for haemodialysis in patients who have undergone coronary artery bypass graft (CABG) surgery, according to research presented here at the American Society of Anesthesiologists (ASA) 2008 Annual Meeting.

Lead investigator Julie Huffmyer, MD, University of Virginia Health System, Charlottesville, Virginia, reported the results here in a poster session on October 19.

Dr. Huffmyer explained that acute renal failure after cardiac surgery is common, with cardiopulmonary bypass often inducing an inflammatory response. Since statins -- also known as 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors -- have shown both anti-inflammatory effects and renal protective properties, this study was designed to investigate whether the mortality benefits of statins in cardiac-surgery patients could be attributed to renal protection.

Dr. Huffmyer indicated that she wished to tackle the challenge of finding "something that is going to change or modulate the risk for renal failure after cardiac surgery in cardiac-surgery patients."

The primary outcomes of this trial were as follows: in-hospital mortality, the need for renal replacement therapy, and acute renal failure (defined as a decrease in the glomerular filtration rate [GFR] of over 50%).

The team retrospectively reviewed the charts of 2,760 patients admitted for isolated CABG surgery over a 10-year period, using the University of Virginia's Clinical Data Repository. Patients were excluded who either had a history of prior renal replacement therapy or who had undergone any intraventricular procedure. Patients were also excluded if they were admitted on the day of surgery, as investigators were concerned that they couldn't have known a patient's home-medication regimen with absolute certainty.

All of the 1,557 subjects taking preoperative statins were then stratified based on whether the statins were administered on the day before or day of surgery. All creatinine levels from admission to discharge were noted, along with any requirement for renal replacement therapy or any change in GFR as calculated by the Abbreviated Modification of Diet in Renal Disease study equation. In addition, patient outcomes on the day of discharge (whether alive or deceased) were also recorded.

Results at the end of the analysis demonstrated a 43% lower postoperative mortality for patients taking statins preoperatively compared with those not taking statins (2.4% vs 4.2%, respectively; P = .008).

Additionally, there was a 46% reduction in the need for haemodialysis in subjects who received preoperative statin therapy compared with those who did not (1.9% vs 3.0%, respectively; P = .011).

There was no difference, however, in the risk of post-CABG renal failure between the statin and non-statin treatment groups (6.5% vs 7.3%, P = .4228).

"We were very surprised that statin medications did not affect the incidence of acute renal failure both on the univariate analysis and the multivariate analysis," Dr. Huffmyer commented. "We thought … that basically renal replacement therapy represents a more significant, more severe form of acute renal failure. We were able to detect a difference based on statins in that population, as compared to patients who just have acute renal failure."

Dr. Huffmyer concluded, "The results of this study … definitely seem to indicate that, with perioperative statin use, there is a decrease in mortality, and we may be able to affect a decrease in the need for renal replacement therapy." She added, "We really need to do a prospective trial to see what statin and which dose is best and how long patients should be on them."


[Presentation title: Preoperative Statin Use Is Associated With a Reduction in Renal Failure After CABG. Abstract 804]

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