Abstract 185: Postoperative Statin Withdrawal After Major Vascular Surgery Is Associated With An Increase In Cardiac Events.
Background: Discontinuation of statin therapy in patients with an acute coronary syndrome has been associated with an increase of adverse coronary events. Patients undergoing major surgery frequently are not able to take oral medication shortly after surgery. Since there is no intravenous formula for statins, interruption of statins in the postoperative period is a serious concern. The objective of this study was to assess the effect of perioperative statin withdrawal on postoperative cardiac outcome. Also, the association between outcome and type of statin was studied.
Methods: In 298 consecutive statin users (100 fluvastatin extended release, 80 mg; 86 simvastatin, 20/40 mg; 35 pravastatin 20/40 mg; and 77 atorvastatin, 10/20/40 mg) undergoing major vascular surgery a detailed cardiac history was obtained and medication use was noted. Postoperatively troponin levels were measured on day 1,3,7,30 and whenever clinically indicated by ECG changes. Endpoints were postoperative troponin release, myocardial infarction, and a combination of non-fatal myocardial infarction and cardiovascular death. Multivariable analyses and propensity score analyses were performed to assess the influence of type of statin and discontinuation of statins for these endpoints.
Results: Statin discontinuation was associated with an increased risk for postoperative troponin release (HR 4.6, 95%CI 2.2–9.6), and the combination of myocardial infarction and cardiovascular death (HR 7.5, 95% CI 2.8–20.1). Importantly, fluvastatin extended release was associated with less perioperative troponin release compared to simvastatin (HR 2.7, 95% CI 1.1– 6.5), pravastatin (HR 6.6, 95% CI 2.2–19.6), and atorvastatin (HR 4.2, 95% CI 1.7–10.4). Also for the endpoint of myocardial infarction and cardiovascular death fluvastatin was associated with less events as compared to simvastatin (HR 4.1, 95% CI 1.1–14.8), pravastatin (HR 5.7 95% CI 1.2–26.8), and atorvastatin (HR 1.3, 95% CI 1.3–16.3).
Conclusion: This study showed that statin withdrawal in the perioperative period is associated with an increased risk for perioperative adverse cardiac events. Furthermore there seems to be a better outcome in patients who received statins with an extended release formula.