Abstract 2997: Post-Operative Statin Use and Lower LDL Cholesterol Concentration Are Associated with Reduced Incidence of Stroke
Background: Post operative stroke remains a catastrophic and costly complication of coronary artery bypass grafting (CABG). Prior work has demonstrated a significant reduction in the rate of stroke associated with statin use in the non-operative setting. We evaluated the effect of post-operative statin use and LDL cholesterol concentration (LDL-C) on the incidence of stroke following CABG.
Methods: The Cleveland Clinic Cardiothoracic Surgery Database was used to identify 5,205 consecutive patients who underwent first time, isolated CABG from 1/1993–12/2005. Patients with a prior history of atrial fibrillation, known clotting disorder, or requirement for anticoagulation were excluded from analysis. Discharge medications, including statins, were prospectively collected. Patients were divided into groups based upon serum LDL-C: <70mg/dl, 70 –100, 101–130, or >130.
Results: The overall incidence of postoperative stroke at 1 year was 3.3% (181 events). Patients discharged on statin therapy were more likely to have a lower LDL-C and were significantly less likely to suffer a post operative stroke at 1 year (see table⇓). Multivariate logistic regression identified age (HR 1.05 [1.024, 1.075]; p<0.001), peripheral vascular disease(1.89[1.233, 2.891]; p<0.004), and renal disease (2.79 [1.654, 4.709]; p<0.001) as independent predictors of the combination of stroke, MI, or death. Use of both statin (0.366 [0.177, 0.757]; p<0.007) and ACE inhibitor (0.545 [0.36, 0.82]; p<0.003) therapies significantly reduced this risk.
Conclusions: In patients undergoing first time, isolated CABG, post-operative statin therapy was associated with lower LDL-C concentration which significantly reduced risk of stroke as well as the composite endpoint of death, MI, or stroke. These data suggest that a discharge regimen including statin therapy may reduce post-operative morbidity and warrants prospective validation.