Perioperative Statin Reloading in Cardiac Surgery: A Review

Author Info

Chengyuan Zhang

Corresponding Author

Chengyuan Zhang
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK

A B S T R A C T

Introduction: There is good evidence that perioperative statin therapy is cardioprotective and reduces postoperative complications after cardiac surgery in statin-naive patients. However, most cardiac surgical patients will already be established on chronic statin therapy. Clinical and experimental evidence suggests that additional doses of statin treatment in this setting may be able to provide further benefit. Methods: MEDLINE using the OVID interface was searched to December 2019 for randomised controlled trials of statin reloading in cardiac surgery. Results: 932 papers were identified of which 5 met eligibility criteria. No study demonstrated a significant difference in clinical endpoints. One study found a 7.3% absolute risk reduction in the odds of postoperative atrial fibrillation which did not reach significance. Two further studies reported a reduction in proinflammatory cytokines. One of these also demonstrated decreased markers of cardiac and renal injury. Discussion: Although statin reloading is cardioprotective in animal models, there is little translational evidence in humans. Current evidence suggests a protective effect of perioperative statin therapy for atrial fibrillation. However, this was not replicated by any of the reloading trials. Furthermore, studies were small trials with significant heterogeneity in both baseline and intervention statin regimens. We conclude that the current evidence base does not support additional statin therapy in patients on chronic statin treatment scheduled for cardiac surgery.

Article Info

Article Type

Research Article

Publication history

Received: Mon 30, Dec 2019
Accepted: Mon 13, Jan 2020
Published: Mon 20, Jan 2020

Copyright

© 2023 Chengyuan Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.HCS.2020.01.01