Abstract 1793: Statins Reduce Perioperative Myocardial Ischemia, Troponin T Release and Mortality in Major Vascular Surgery
Background: HMG-CoA reductase inhibitors (statins) improve mortality in high-risk patients. Statins may have beneficial properties beyond its lipid-lowering potential, including inflammation reduction and atherosclerotic plaque stabilization. In this study, we examined whether statins can reduce perioperative myocardial ischemia and improve long-term outcome in patients undergoing major vascular surgery.
Methods: A total of 213 consecutive patients (mean age 68 ± 10 years, 79% male) underwent surgery for abdominal aortic aneurysms or lower extremity bypass grafting. Statins were prescribed in 55% of the patients and serial cholesterol levels were measured 3 months and 1 week prior to surgery. Myocardial ischemia was assessed by continuous 12-lead ECG monitoring, starting 1 day before surgery and continuing for 3 days after. Serial troponin T measurements were performed on day 1, 3 and 7 after surgery. During follow-up, mortality was noted.
Results: In this study cohort, 71 patients (33%) had myocardial ischemia on 12-lead ECG, 33 patients (15%) had troponin T release and 61 patients (29%) died during a median follow-up of 3.3 years (IQ range: 0.7– 6.8). Using multivariate regression analysis with adjustment for baseline characteristics and propensity scores, statin therapy was significantly associated with a reduced incidence of myocardial ischemia (OR: 0.36, 95% CI: 0.17– 0.74, p= 0.006), reduced troponin T release (OR: 0.43, 95% CI: 0.25– 0.89, p = 0.009) and improved long-term survival (HR: 0.44, 95% CI: 0.25– 0.76, p = 0.003). The reduction in LDL-cholesterol level prior to surgery was not significantly associated with the occurrence of myocardial ischemia (OR per % reduction: 0.99, 95% CI: 0.98–1.01, p = 0.59) and troponin T release (OR per % reduction: 1.00, 95% CI: 0.98 –1.02, p = 0.97).
Conclusion: Statin therapy in patients undergoing major non-cardiac vascular surgery is associated with a reduced incidence of perioperative myocardial ischemia, troponin T release and long-term mortality rate. In patients using statins, LDL-cholesterol reduction prior to surgery was not associated with reduced myocardial ischemia, suggesting that other than lipid-lowering properties of statins may be responsible for its beneficial effect.