Effects of adding statins before surgery on mortality and major morbidity: a meta-analysis

Abstract

Objective: To re-evaluate the effects of adding a statin before surgery on mortality at 30 days and at 1 year and on major morbidity at 0-30 days.

Design: A meta-analysis of parallel, randomized, controlled trials published in English.

Setting: A university-based electronic search.

Participants: Adult patients undergoing any type of procedure.

Intervention: Adding a statin before a procedure compared to a placebo or no intervention.

Measurements and main results: A search for all randomized controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the Cochrane Central Register of Controlled Trials in November 2012. The quality of each study was assessed with the Cochrane Collaboration Tools. An I-square ≥ 25% was chosen as the cut-off point for heterogeneity exploration. The search produced 29 trials. Statins reduced the 0-30 days' risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61); I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95), acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10 (0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26 (0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was slightly decreased with atorvastatin: standardized mean difference (SMD) -0.27 (-0.39, -0.14), p<0.001; fluvastatin SMD -0.95 (-1.56, -0.34), p = 0.002; and rosuvastatin SMD -0.69 (-0.98, -0.40), p<0.001 but not with simvastatin SMD -0.04 (-0.41, 0.48).

Conclusions: Adding a statin before a high risk cardiac procedure reduces the 0-30 days' risk of myocardial infarction.

Keywords: death; hospital; intensive care unit; length of stay; myocardial infarction; renal insufficiency; statins; stroke; surgery.