Sung Y Ham1,2, Suk W Song3, Sang B Nam1,2, Soo J Park1,2, Sijin Kim1, Young Song4,2. 1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea. 2. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea. 3. Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea. 4. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea - nearmyheart@yuhs.ac.
Abstract
BACKGROUND: Cardiac and cerebrovascular complications are major causes of adverse outcomes following thoracic endovascular aortic repair (TEVAR). The benefits of statins have been established, but little is known about their impact on patients undergoing TEVAR. We investigated whether chronic statin use protected against early postoperative major adverse cardiac and cerebrovascular events (MACCEs) after TEVAR. METHODS: We retrospectively reviewed 211 patients who underwent TEVAR between February 2013 and March 2017 classified into two groups, those with acute aortic syndrome (AAS, N.=79) and those without (non-AAS, N.=132). Patients were subdivided according to preoperative statin therapy for ≥3 months or not. The primary endpoint was 30-day MACCE, defined as myocardial infarction, stroke, arrhythmia, cardiovascular death, or cerebrovascular death. Acute kidney injury (AKI) occurrence within 48 hours was also evaluated. Multivariate logistic regression analysis was performed to identify independent risk factors for MACCEs and AKI. RESULTS: Incidence of MACCEs (1% vs. 11%, P=0.019) was significantly lower in the statin group than in the no-statin group in non-AAS patients. Multivariate logistic regression analysis revealed statin use (odds ratio 0.85, 95% confidence interval 0.01-0.95, P=0.046) as an independent predictor for MACCE in non-AAS patients. The AKI incidence was significantly higher in the statin group than in the no-statin group in AAS patients (44% vs. 15%, P=0.018). CONCLUSIONS: In patients undergoing TEVAR, chronic statin use was associated with reduced 30-day MACCEs in non-AAS patients, but not in AAS patients. It might rather be associated with increased risk of AKI in AAS patients.
BACKGROUND: Cardiac and cerebrovascular complications are major causes of adverse outcomes following thoracic endovascular aortic repair (TEVAR). The benefits of statins have been established, but little is known about their impact on patients undergoing TEVAR. We investigated whether chronic statin use protected against early postoperative major adverse cardiac and cerebrovascular events (MACCEs) after TEVAR. METHODS: We retrospectively reviewed 211 patients who underwent TEVAR between February 2013 and March 2017 classified into two groups, those with acute aortic syndrome (AAS, N.=79) and those without (non-AAS, N.=132). Patients were subdivided according to preoperative statin therapy for ≥3 months or not. The primary endpoint was 30-day MACCE, defined as myocardial infarction, stroke, arrhythmia, cardiovascular death, or cerebrovascular death. Acute kidney injury (AKI) occurrence within 48 hours was also evaluated. Multivariate logistic regression analysis was performed to identify independent risk factors for MACCEs and AKI. RESULTS: Incidence of MACCEs (1% vs. 11%, P=0.019) was significantly lower in the statin group than in the no-statin group in non-AASpatients. Multivariate logistic regression analysis revealed statin use (odds ratio 0.85, 95% confidence interval 0.01-0.95, P=0.046) as an independent predictor for MACCE in non-AASpatients. The AKI incidence was significantly higher in the statin group than in the no-statin group in AASpatients (44% vs. 15%, P=0.018). CONCLUSIONS: In patients undergoing TEVAR, chronic statin use was associated with reduced 30-day MACCEs in non-AASpatients, but not in AASpatients. It might rather be associated with increased risk of AKI in AASpatients.
Authors: Nathan J Smischney; Andrew D Shaw; Wolf H Stapelfeldt; Isabel J Boero; Qinyu Chen; Mitali Stevens; Ashish K Khanna Journal: Crit Care Date: 2020-12-07 Impact factor: 9.097
Authors: Anne Gregory; Wolf H Stapelfeldt; Ashish K Khanna; Nathan J Smischney; Isabel J Boero; Qinyu Chen; Mitali Stevens; Andrew D Shaw Journal: Anesth Analg Date: 2021-06-01 Impact factor: 6.627