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Previous Volume 361:980-989 September 3, 2009 Number 10 Next

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ABSTRACT

Background Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes.

Methods In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a statin to receive, in addition to a beta-blocker, either 80 mg of extended-release fluvastatin or placebo once daily before undergoing vascular surgery. Lipid, interleukin-6, and C-reactive protein levels were measured at the time of randomization and before surgery. The primary end point was the occurrence of myocardial ischemia, defined as transient electrocardiographic abnormalities, release of troponin T, or both, within 30 days after surgery. The secondary end point was the composite of death from cardiovascular causes and myocardial infarction.

Results A total of 250 patients were assigned to fluvastatin, and 247 to placebo, a median of 37 days before vascular surgery. Levels of total cholesterol, low-density lipoprotein cholesterol, interleukin-6, and C-reactive protein were significantly decreased in the fluvastatin group but were unchanged in the placebo group. Postoperative myocardial ischemia occurred in 27 patients (10.8%) in the fluvastatin group and in 47 (19.0%) in the placebo group (hazard ratio, 0.55; 95% confidence interval [CI], 0.34 to 0.88; P=0.01). Death from cardiovascular causes or myocardial infarction occurred in 12 patients (4.8%) in the fluvastatin group and 25 patients (10.1%) in the placebo group (hazard ratio, 0.47; 95% CI, 0.24 to 0.94; P=0.03). Fluvastatin therapy was not associated with a significant increase in the rate of adverse events.

Conclusions In patients undergoing vascular surgery, perioperative fluvastatin therapy was associated with an improvement in postoperative cardiac outcome. (Current Controlled Trials number, ISRCTN83738615 [controlled-trials.com] .)

Source Information

From the Departments of Surgery (O.S., H.U., M.R.H.M.S., H.J.M.V., M.D.), Cardiology (E.B., S.E.H.), Immunology (R.B., N.A.K.), and Anesthesiology (D.P.), Erasmus Medical Center, Rotterdam; the Department of Surgery, Catharina Hospital, Eindhoven (M.R.H.M.S.); and the Department of Cardiology, Leiden University Medical Center, Leiden (J.J.B.) — all in the Netherlands.

Address reprint requests to Dr. Poldermans at Erasmus Medical Center, Gravendijkwal 230, Rm. H-805, 3015 CE Rotterdam, the Netherlands, or at d.poldermans{at}erasmusmc.nl.

Full Text of this Article

This article has been cited by other articles:

• POLDERMANS, D. (2009). Statins and noncardiac surgery: Current evidence and practical considerations. Cleveland Clinic Journal of Medicine 76: S79-S83 [Abstract] [Full Text]  
• (2009). Statins to Prevent Perioperative Cardiovascular Events. JWatch General 2009: 5-5 [Full Text]