Cardiac surgery offers a highly efficient therapeutic option to patients with heart disease, but bears at the same time a significant risk of the development of post-operative adverse events. Despite the increasing proportion of patients referring to cardiac surgery with major comorbidities, the operative results have remained stable during the past decades due to significant advancements of surgical techniques. Nonetheless, perioperative care of patients referring to cardiac surgery still needs to be optimized to further improve patients´ outcomes. Statins (HMG-CoA reductase inhibitors) are known to provide beneficial effects beyond their lipid-lowering properties in patients with atherosclerotic cardiovascular disease in terms of a reduction of mortality from adverse cardiovascular events. However, evidence for the beneficial statin effects for patients undergoing cardiac surgery is inconsistent since it is mainly extracted from observational studies and only a few small randomized clinical trials.
The aim of this review is to determine the current evidence of preoperative statin therapy on the reduction of major adverse cardiovascular events in patients referred to cardiac surgical procedures.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the metaRegister of Controlled Trials. Eleven studies dating from 1999 to 2010 with a total of 984 participants undergoing cardiac surgical procedures were identified. All included trials were randomized studies comparing statin treatment with a control intervention (no statin medication) or placebo in patients that were predominantly referred to coronary artery bypass grafting surgery.
Preoperative statin therapy resulted in a reduction of post-operative AF and a shorter length of stay both on the ICU and in the hospital. Although statin-pretreatment was associated with lower incidences of myocardial infarction and renal failure, these results did not reach statistical significance. Furthermore, statin therapy had no impact on short-term mortality and post-operative stroke. No serious side effects of a statin therapy prior to cardiac surgery were reported. However, all analysed studies included mainly patients undergoing coronary bypass operations, thus, the results of this study may not be generalisable to patients undergoing cardiac procedures other than coronary artery bypass grafting.