This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: October 28, 2008, Volume 118, Number 18 All Versions of this Article: 118/18/1785    most recent CIRCULATIONAHA.108.799445v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kulik, A. Articles by Choudhry, N. K. Search for Related Content PubMed PubMed Citation Articles by Kulik, A. Articles by Choudhry, N. K. Related Collections Lipids Cardiovascular Pharmacology Secondary prevention CV surgery: coronary artery disease Related Article

(Circulation. 2008;118:1785-1792.)
© 2008 American Heart Association, Inc.

Cardiovascular Surgery

Impact of Statin Use on Outcomes After Coronary Artery Bypass Graft Surgery

Alexander Kulik, MD, MPH; M. Alan Brookhart, PhD; Raisa Levin, MS; Marc Ruel, MD, MPH; Daniel H. Solomon, MD, MPH; Niteesh K. Choudhry, MD, PhD

From the Division of Cardiac Surgery (A.K., M.R.), University of Ottawa Heart Institute, Ottawa, Canada, and the Division of Pharmacoepidemiology and Pharmacoeconomics (M.A.B., R.L., D.H.S., N.K.C.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Niteesh K. Choudhry, MD, PhD, Brigham and Women’s Hospital, 1620 Tremont St, Suite 3030, Boston, MA 02120. E-mail nchoudhry{at}partners.org

Received August 31, 2007; accepted August 29, 2008.

Background— The benefits of statins have been demonstrated for patients with a remote history of coronary artery bypass grafting (CABG); however, no investigation to date has evaluated whether initiation of statin therapy in the early months after surgery improves clinical outcomes.

Methods and Results— A retrospective cohort of 7503 Medicare patients 65 years of age who underwent CABG (1995–2003) was assembled by use of linked hospital and pharmacy claims data. Rates of all-cause mortality and major adverse cardiovascular events were compared between patients who were (n=1745) and were not (n=5788) prescribed statins within 1 month of CABG discharge. Additional analyses evaluated the impact of statin initiation between 1 and 6 months after surgery. Multivariable and propensity score analysis demonstrated that statin use within 1 month of CABG discharge independently reduced the risk of all-cause mortality (adjusted hazard ratio 0.82, 95% confidence interval 0.72 to 0.94) compared with no statin use. Similarly, statin use within 1 month of CABG discharge independently reduced the risk of major adverse cardiovascular events (adjusted hazard ratio 0.89, 95% confidence interval 0.81 to 0.98). Initiation of statin therapy between 1 and 6 months after CABG discharge was also associated with reductions in major adverse cardiovascular events and mortality; however, outcome rates between early (1 month after CABG) and delayed (1 to 6 months after CABG) statin initiation were not significantly different.

Conclusions— Statin therapy initiated in the early months after hospital discharge independently reduces all-cause mortality and major adverse cardiovascular events after CABG. These findings validate the widespread practice of prescribing long-term statin therapy after CABG.

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CLINICAL PERSPECTIVE

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