By Roberta Friedman, PhD
SAN FRANCISCO -- January 27, 2009 -- Statin use prior to undergoing surgical valve repair has no effect on 5-year survival after valve surgery, researchers reported here at the Society of Thoracic Surgeons (STS) 45th Annual Meeting.
According to Michael A. Borger, MD, PhD, Leipzig Heart Centre, Leipzig, Germany, patients who had taken statins before undergoing heart valve surgery actually had reduced survival 5 years after their operation compared with those patients not taking statins (69.7% vs 72.4%, P < .001).
This large study of 15,096 patients showed a robust statistical difference for this difference in survival rate. But Dr. Borger emphasised that a multivariate analysis did not sustain the difference and that clinical benefit or detriment is not evident for statin use in patients undergoing valve repairs.
"We should not be using statins as a panacea for valve surgery, nor is statin use a negative," Dr. Borger said in a presentation on January 26.
The conclusion contradicts other smaller studies that have suggested a survival benefit to using statins for those who need heart valve repairs.
In Dr. Borger's study, nearly 9,000 patients had been on statin therapy, almost two-thirds of the total number included in the analysis.
Valve repairs took place between May 1996 and May 2008 at the Leipzig Heart Centre. Patients were aged 66 years on average (range 54-78 years), and 60% were men. The aortic valve was operated on in 65% of patients, the mitral valve in 44%, and the tricuspid valve in 8%; some patients had more than 1 valve repaired.
Coronary artery bypass grafting was carried out in 33% of patients who were taking statins and in 31% of those not on the drugs, a difference that was not statistically significant.
Mean left ventricular ejection fraction was 54%. Perioperative EuroSCORE to predict risk of mortality averaged 10.1%. All patients were available for follow-up.
Patients receiving statins were more likely to have low cardiac output compared with those not taking statins (8.2% vs 6.7%, P = .002). Death within 30 days of surgery occurred in 7.5% and 6.9% of the patient groups, respectively (P < .001). There was no difference in the rates of myocardial infarction.
"There is insufficient evidence to recommend statin use to patients undergoing valvular surgery," Dr. Borger said.
He added that the use of aspirin and beta-blockers is likely to be of cardiovascular benefit and was twice as high in statin users as in patients not taking statins. Thus, he noted, these patients may be better treated in general prior to their valve surgeries.
[Presentation title: Effect of Statin Therapy on Perioperative and Long-Term Outcomes of Valve Surgery. Abstract 4]
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