Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials

Putzu, Alessandro; Capelli, Bruno; Belletti, Alessandro; Cassina, Tiziano; Ferrari, Enrico; Gallo, Michele; Casso, Gabriele; Landoni, Giovanni

doi:10.1186/s13054-016-1560-6

Critical Care

Table 1 Characteristics of the trials included in the analysis

From: Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials

Trial	Journal	Cardiac surgery procedure	Number of patients	Statin	Statin regimen	Duration of preoperative therapy	Control	Patients naïve to statin therapy?	Outcomes for meta-analysis	Risk of bias
Almansob 2012 [31]	Arterioscler Thromb Vasc Biol	Non coronary cardiac surgery	132	Simvastatin 20 mg	5–7 days preop and from day 2 postop (no day 0)	5–7 days	No treatment	NR	AF, MI, S, M	High
Baran 2012 [32]	Stem Vell Rev and Rep	CABG	60	Atorvastatin 40 mg	2 weeks preop and postop (no day 0)	2 weeks	Placebo	Yes (>3 months)	AKI, AF, MI, S, M	High
Berkan 2009 [33]	Thorac Cardiov Surg	CABG	46	Fluvastatin 80 mg	3 weeks preop	3 weeks	Placebo	Yes (>1 year)	MI	High
Billings 2016 [21]	JAMA	CABG (49%), valve, or ascending aortic surgery	615	Atorvastatin 40 mg	Bid day 1^b, qd day 0, and qd postop	2 days	Placebo	No (Naïve 32%)	AKI, AF, MI, S, M, I	Low
Caorsi 2008 [34]	Eur Cytokine Netw	On-pump CABG	43	Pravastatin 40 mg	2 days preop, 1 hour after CPB, and 7 days postop	2 days	No treatment	NR	AF	High
Carrascal 2016 [51]	J Arrhythm	Valve surgery	90	Atorvastatin 40 mg	7 days preop and 7 days postop	7 days	No treatment	Yes	AKI, AF, MI, S, M	High
Castaño 2015 [35]	J Cardiovasc Surg	On-pump CABG	30	Pravastatin 80 or 40 mg	2 hours before surgery	1 days	Placebo	No (Naïve 0%)	AF, MI, M	Unclear
Chello 2006 [36]	Crit Care Med	On-pump CABG	40	Atorvastatin 20 mg	3 weeks preop	3 weeks	Placebo	Yes (>1 year)	AKI, AF, MI, S, M, I	Unclear
Christenson 1999 [37]	Eur J Cardiothorac Surg	On-pump CABG	77	Simvastatin 20 mg	4 weeks preop	4 weeks	No treatment	NR	AKI, MI, M, I	High
Dehghani 2015 [38]	J Cardiovasc Pharmacol Ther	Valve surgery	58	Atorvastatin 40 mg	3 days preop and 5 days postop	3 days	Placebo	Yes	AF, MI, S, M	Unclear
Ji 2009 [39]	Circ J	Off-pump CABG	140	Atorvastatin 20 mg	7 days preop	7 days	Placebo	Yes	AF, MI, S, M	High
Mannacio 2008 [40]	J Thorac Cardiovasc Surg	On-pump CABG	200	Rosuvastatin 20 mg	7 days preop	7 days	Placebo	Yes (>1 month)	AKI, AF, MI, S, M, I	High
Melina 2009 [41]^a	Eur Heart J	On- off-pump CABG	632	Atorvastatin 40 mg	NR	NR	Placebo	NR	AF	High
Park 2016 [42]	Intensive Care Med	Valve surgery	200	Atorvastatin 40 mg	Bid day 1, qd day 0, and qd 3 days postop^b	2 days	Placebo	Yes	AKI, AF, MI, S, M	Unclear
Patti 2006 [43]	Circulation	On-pump cardiac surgery (CABG 79%)	200	Atorvastatin 40 mg	7 days preop and postop until discharge (no day 0)	7 days	Placebo	Yes (>1 year)	AF, MI, M	High
Prowle 2012 [44]	Nephrology	On-pump cardiac surgery (CABG 57%)	100	Atorvastatin 40 mg	Days 0 and 3 days postop	1 days	Placebo	No (Naïve 30%)	AKI, M	Low
Song 2008 [45]	Am Heart J	Off-pump CABG	124	Atorvastatin 20 mg	3 days preop, after surgery, and 30 days postop	3 days	No treatment	Yes	AF, MI, S	High
Spadaccio 2010 [46]	J Cardiovasc Pharmacol	On-pump CABG	50	Atorvastatin 20 mg	3 weeks preop	3 weeks	Placebo	Yes (>1 year)	AKI, AF, MI, S, M, I	Unclear
Sun 2011 [47]	Int Heart J	On-pump CABG	100	Atorvastatin 20 mg	7 days preop	7 days	Placebo	Yes (>14 days)	AF, MI	High
Tamayo 2009 [50]	J Thorac Cardiovasc Surg	On-pump CABG	44	Simvastatin 20 mg	3 weeks preop	3 weeks	No treatment	Yes (>3 weeks)	AF, M	High
Vukovic 2011 [48]	Perfusion	On-pump CABG	57	Atorvastatin 20 mg	3 weeks preop	3 weeks	Placebo	Yes (>1 year)	AF, MI, M, I	High
Youn 2011 [49]	Korean J Thorac Cardiovasc Surg	Off-pump CABG	142	Rosuvastatin 20 mg	Bid day 1, qd day 0	2 days	No treatment	No (Naïve 45%)	MI, M	High
Zheng 2016 [22]	N Engl J Med	On-pump CABG (42%), off-pump CABG (43%), AVR, AVR + CABG	1922	Rosuvastatin 20 mg	1–8 days preop and 5 days postop	8 days	Placebo	No (Naïve 66%)	AKI, AF, MI, S, M, I	Low

^aAbstract-only publication. ^bPatients on chronic statin therapy received study drug only on day 0 and day 1, resuming chronic statin therapy on postoperative day 2. CABG coronary artery bypass grafting, AVR aortic valve replacement, CPB cardiopulmonary bypass, preop preoperative regimen, postop postoperative regimen, day 0 the morning of the day of surgery, qd once a day, bid twice a day, AF atrial fibrillation, AKI acute kidney injury, MI myocardial infarction, I infection, M mortality, NR not reported

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ISSN: 1364-8535

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