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Failure to initiate statin therapy during and after percutaneous coronary interventions negatively affects coronary artery bypass graft outcomes
EDITORIAL COMMENTARY
Failure to initiate statin therapy during and after percutaneous coronary interventions negatively affects coronary artery bypass graft outcomes Harold L. Lazar, MD
See related article on pages 1876-83.
Studies have shown that patients who have had a previous percutaneous coronary intervention (PCI) and subsequently require coronary artery bypass graft (CABG) surgery have increased perioperative morbidity and mortality and decreased long-term survival.1-4 Tran and colleagues3 found that patients with diabetes mellitus who had previously undergone a PCI and subsequently underwent CABG surgery had nearly a 3-fold increase in operative mortality, increased risk of developing a major adverse cardiac event (MACE), and significantly reduced 2-year survival compared with patients without a previous PCI. In an editorial accompanying this study, it was noted that the use of statin therapy in both groups was especially low (<40%).5 The question was raised on whether the outcomes would have improved in the PCI cohort undergoing CABG if these patients had received statin therapy after their PCI and before their surgery. This issue is now addressed in the study by Mannacio and colleagues in this issue of The Journal of Thoracic and Cardiovascular Surgery.6 In this study of 2501 patients who had undergone a previous PCI and now required CABG surgery, 1528 patients were on continuous statin therapy and 973 patients did not receive a statin until immediately before their surgery. A propensity-matched conditional logistic regression analysis showed that continued statin therapy significantly reduced the risk for in-hospital and 2-year mortality and MACE. Statins were particularly effective in those patients who had prolonged crossclamp times and patients with previous multivessel PCI. Patients on continuous statin therapy had significantly lower lowdensity lipoprotein cholesterol (LDL-c) levels at the time of surgery (120 28 mg/dL vs 159 39 mg/dL; P<.001). There were several limitations in this study. It was retrospective and urgent and emergency patients were From the Division of Cardiac Surgery, Boston Medical Center, Boston, Mass. Disclosures: Author has nothing to disclose with regard to commercial support. Received for publication Sept 18, 2014; accepted for publication Sept 19, 2014. Address for reprints: Harold L. Lazar, MD, Division of Cardiac Surgery, Boston Medical Center, 88 East Newton St, Boston, MA 02118 (E-mail: harold.lazar@ bmc.org). J Thorac Cardiovasc Surg 2014;148:1884-6 0022-5223/$36.00 Copyright Ó 2014 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.09.055
1884
excluded. Different types of statins were used and the dosages varied widely. Adherence was assessed by the rates of prescription refills and not by actual documentation that patients took their medication. Nearly 35% of the patients had diabetes mellitus but no mention was made of the use of perioperative glycemic control or the preoperative glycated hemoglobin values between the groups. The use of other cardioprotective agents was poor; only 22% of patients received an angiotensin-converting enzyme (ACE) inhibitor and only 70% were on a b-blocker at the time of surgery. Cardiac catheterization data were not available at the time of the PCI so that the completeness of the revascularization performed during PCI for both groups was unknown. Nevertheless, this study is important in that it adds to previous reports showing that statins given before CABG and continued in the postoperative period resulted in significant decreases in 30-day mortality and MACE and increased long-term survival.7-10 Furthermore, these results are particularly important and impressive because all the patients in both groups received a statin 24 hours after surgery, which was then continued during the follow-up period. The fact that statins were particularly effective in those patients with prolonged crossclamp times and previous multivessel PCI suggests that these beneficial effects may have resulted from the decrease in the inflammatory response both acutely and in those patients with higher atherosclerotic burdens stemming from the pleiotropic effects of statins.11,12 These findings support the current guideline recommendations that all patients undergoing CABG should receive statin therapy to achieve a result that will reduce LDL-c levels to less than 100 mg/dL and less than 70 mg/dL in high-risk patients; and to achieve at least a 30% lowering of LDL-c levels in all patients.13 It also sends the important message to our medical colleagues that initiating and sustaining statin therapy after a PCI will significantly affect the results after future CABG surgery. Evidence is now emerging that statins are also beneficial to patients undergoing PCI. In a meta-analysis of 4805 patients undergoing PCI, statin therapy at the time of the procedure significantly reduced the incidence of periprocedural myocardial infarction (MI).14 In a review of 13 randomized studies involving 3341 patients undergoing PCI, the use of high-dose statin therapy reduced the risk of an MI or MACE by 44%.15 In a small study involving
The Journal of Thoracic and Cardiovascular Surgery c November 2014
Lazar
Editorial Commentary
171 PCI patients with acute coronary syndromes, atorvastatin significantly decreased the incidence of periprocedural MI and resulted in an 88% reduction in MACE.16 Chan and colleagues17 showed that statin therapy initiated at the time of PCI significantly reduced mortality at 30 days and at 6 months and that the mechanism was independent of any lowering of lipid levels.17 Several prospective randomized trials have also demonstrated that statin pretreatment with fixed doses of a specific statin provides significant cardioprotection during PCI.16,18,19 The favorable effects of statins may be related to their ability to decrease inflammatory processes, which are known to be increased during PCI.11 They have been shown to reduce C-reactive protein, improve endothelial function, and reduce platelet activation, which are all involved in the inflammatory response during PCI.12,20,21 In view of these advantages of statin therapy during and after PCI, why is the use of statin therapy in these patients not more common? Several explanations have been proposed: 1. Economic limitations: these drugs are expensive and may not be affordable or covered by all existing medical plans. 2. Physician philosophy: some primary care physicians are unlikely to begin statin therapy on patients with increase LDL-c levels if they are asymptomatic. 3. Patient issues: after a revascularization procedure, either a PCI or CABG, patients feel so much better and their angina is gone so that they no longer believe it is necessary to take extra medications and that their disease is cured. What can a surgeon do to make sure that patients remain on statin therapy after their CABG? This becomes important because in most practices, after surgery and at the initial postoperative visit, these patients are followed by cardiologists and primary care physicians whose role is to make sure that the guidelines for statin therapy after CABG are followed. This is especially crucial for those patients who undergo a PCI as their initial revascularization procedure and may not see a surgeon unless they require a CABG. In the past, surgeons have been reluctant to initiate statin therapy during the preoperative or postoperative period, believing that it was the responsibility of the cardiologist or referring physician to initiate lipid-lowering therapy. However, it is now well known that initiating statin therapy at the time of CABG or an acute coronary event not only decreases morbidity and mortality but it is more likely that patients will be more compliant with taking these medications in the long term. Muhlestein and colleagues22 found that patients who received a prescription for a statin on discharge from the hospital after an acute coronary event had better long-term compliance and reduced long-term mortality. In the Cardiac
Hospitalization Arterial Sclerosis Management Program (CHAMP), the initiation of statins, ACE inhibitors, aspirin, and b-blockers after an acute MI before hospital discharge increased the use of statins from 6% to 86% (P<.01).23 At the 1-year follow-up, compliance was 91% and 58% of CHAMP patients had an LDL-c level less than 100 mg/dL compared with only 6% of pre-CHAMP patients.24 This resulted in a significant reduction in the incidence of deaths, MIs, and repeat hospitalization over an 8-year period. Starting patients on statin therapy in the hospital after CABG surgery conveys the message to the patient that this is an important medication that may prevent another operation and prolong survival. I tell all my patients that they will need to be on a statin with a targeted level of less than 100 mg/dL, or less than 70 mg/dL if they have diabetes, for the rest of their lives. These data are sent to the referring cardiologist and primary care physician and are included in the discharge summary. We now know that revascularization alone is not sufficient to prevent recurrent ischemic events. By initiating statin therapy in all our patients undergoing CABG and educating them on the importance of targeted lipid therapy, we can provide them with the most optimal surgical as well as medical therapy to protect them from recurrent ischemic events. CONCLUSIONS Patients who have had a previous PCI and subsequently require CABG surgery have increased perioperative morbidity and mortality and decreased long-term survival. However, a study by Mannacio and colleagues6 has shown that patients who have received continuous statin therapy since their PCI have reduced risk for in-hospital and 2-year mortality compared with patients who did not receive statin therapy. References 1. Massoudi P, Thielman M, Lehmann N, Marr A, Kleikamp G, Malezka A, et al. Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multi-center analysis. J Thorac Cardiovasc Surg. 2009; 137:840-5. 2. Bonaros N, Hennerbichler V, Friedrich G, Kocher A, Pachinger O, Laufer G, et al. Increased mortality and perioperative complications in patients with previously elective percutaneous coronary interventions undergoing coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2009;137:846-52. 3. Tran HA, Barnett SD, Hunt SL, Chan A, Ad N. Effect of previous coronary artery stenting on short and intermediate term outcome after surgical revascularization in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2009;138:316-23. 4. Mannacio V, DiTommaso L, DeAmicis D, Lucchetti V, Pepino P, Musumeci F, et al. Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery. Ann Thorac Surg. 2012;93:1956-63. 5. Lazar HL. Detrimental effects of coronary stenting on subsequent coronary artery bypass surgery: is there another flag on the field. J Thorac Cardiovasc Surg. 2009;138:276-7. 6. Mannacio V, Meier P, Antignano A, Mottola M, Luigi DT, Musumeci F, et al. Continuative statin therapy after percutaneous coronary interventions improves outcome in coronary bypass surgery: a propensity score analysis of 2501 patients. J Thorac Cardiovasc Surg. 2014;148:1876-83. 7. Clark LL, Ikonomidis JS, Crawford FA, Crumbley A, Kratz JM, Stroud MR, et al. Perioperative statin therapy is associated with reduced postoperative mortality
The Journal of Thoracic and Cardiovascular Surgery c Volume 148, Number 5
1885
Editorial Commentary
8.
9.
10.
11.
12.
13.
14. 15.
16.
and morbidity in patients undergoing cardiac surgery: an eight year retrospective cohort study. J Thorac Cardiovasc Surg. 2006;131:679-85. Pan W, Dintar T, Anton J, Lee VV, Vaughn WK, Collard CD. Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. Circulation. 2004;110(Suppl II):II45-9. Dotani MI, Elnicki VM, Jain AC, Gibson CM. Effect of perioperative statin therapy in cardiac outcomes after coronary artery bypass grafting. Am J Cardiol. 2000;86:1128-30. Mannacio VA, Iorio V, DeAmicis V, DiLell F, Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial. J Thorac Cardiovasc Surg. 2008;136:1541-8. Gottsaunner-Wolf M, Zasmeta G, Hornykewycz S, Nikfardjam M, Stepan E, Wexberg P, et al. Plasma levels of c-reactive protein after coronary stent implantation. Eur Heart J. 2000;21:1152-8. Albert MA, Danielson E, Rifai N. Effects of statin therapy on c-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE). A randomized trial and cohort study. JAMA. 2001;286:64-70. Hillis D, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2001 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary. J Am Coll Cardiol. 2011;58:2584-614. Winchester DE, Wen X, Xie L, Baury AA. Evidence of pre-procedure statin therapy: a meta-analysis of randomized trials. J Am Coll Cardiol. 2010;56:1099-109. Patti G, Cannon CP, Murphy SA, Mega S, Pasceri V, Briguouri C, et al. Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies. Circulation. 2011;123:1622-32. Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti P, Sardell G, et al. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early coronary interventions: results of the ARMYVA-ACS randomized trial. J Am Coll Cardiol. 2007;49:1272-8.
1886
Lazar
17. Chan AW, Bhatt DL, Chu VP, Quinn MJ, Moliterno VJ. Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention. Circulation. 2002;195:691-6. 18. Pasceri V, Patti G, Nusca A, Priscipino C, Richichi G, DiSciasco G, ARMYVA investigators. A randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the Armada (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) study. Circulation. 2004;110:674-8. 19. Yun KH, Jeong Jong MH, Oh SK, Rhee SJ, Park EM, Li EM, et al. The beneficial effects of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol. 2009; 137:246-51. 20. Dupuis J, Tardif JC, Cernacek P. Cholesterol reduction rapidly improves endothelial function after acute coronary syndromes: the RECIFE (Reduction of Cholesterol in Ischemia and Function of the Endothelium) trial. Circulation. 1999;99:3227-33. 21. Keidar S, Aviram M, Maor I, Oiknine J, Brook JG. Pravastatin inhibits cellular cholesterol synthesis and increases low density lipoprotein receptor activity and macrophages: in vitro and in vivo studies. Br J Clin Pharmacol. 1994;38: 513-9. 22. Muhlestein JB, Horne BD, Blir TL. Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol. 2001;87:257-61. 23. Fonarow GC, Gawlinski A, Moughrabi S, Tillish JH. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001;87: 819-22. 24. Fonarow GC, Gawlinski A, Watson KA, Moughrabi S. Sustained improvement in treatment of Cardiovascular Hospitalization Atherosclerosis Management Program (CHAMP). Circulation. 2001;104:II-711.
The Journal of Thoracic and Cardiovascular Surgery c November 2014
Failure to initiate statin therapy during and after percutaneous coronary interventions negatively affects coronary artery bypass graft outcomes Harold L. Lazar, MD
See related article on pages 1876-83.
Studies have shown that patients who have had a previous percutaneous coronary intervention (PCI) and subsequently require coronary artery bypass graft (CABG) surgery have increased perioperative morbidity and mortality and decreased long-term survival.1-4 Tran and colleagues3 found that patients with diabetes mellitus who had previously undergone a PCI and subsequently underwent CABG surgery had nearly a 3-fold increase in operative mortality, increased risk of developing a major adverse cardiac event (MACE), and significantly reduced 2-year survival compared with patients without a previous PCI. In an editorial accompanying this study, it was noted that the use of statin therapy in both groups was especially low (<40%).5 The question was raised on whether the outcomes would have improved in the PCI cohort undergoing CABG if these patients had received statin therapy after their PCI and before their surgery. This issue is now addressed in the study by Mannacio and colleagues in this issue of The Journal of Thoracic and Cardiovascular Surgery.6 In this study of 2501 patients who had undergone a previous PCI and now required CABG surgery, 1528 patients were on continuous statin therapy and 973 patients did not receive a statin until immediately before their surgery. A propensity-matched conditional logistic regression analysis showed that continued statin therapy significantly reduced the risk for in-hospital and 2-year mortality and MACE. Statins were particularly effective in those patients who had prolonged crossclamp times and patients with previous multivessel PCI. Patients on continuous statin therapy had significantly lower lowdensity lipoprotein cholesterol (LDL-c) levels at the time of surgery (120 28 mg/dL vs 159 39 mg/dL; P<.001). There were several limitations in this study. It was retrospective and urgent and emergency patients were From the Division of Cardiac Surgery, Boston Medical Center, Boston, Mass. Disclosures: Author has nothing to disclose with regard to commercial support. Received for publication Sept 18, 2014; accepted for publication Sept 19, 2014. Address for reprints: Harold L. Lazar, MD, Division of Cardiac Surgery, Boston Medical Center, 88 East Newton St, Boston, MA 02118 (E-mail: harold.lazar@ bmc.org). J Thorac Cardiovasc Surg 2014;148:1884-6 0022-5223/$36.00 Copyright Ó 2014 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.09.055
1884
excluded. Different types of statins were used and the dosages varied widely. Adherence was assessed by the rates of prescription refills and not by actual documentation that patients took their medication. Nearly 35% of the patients had diabetes mellitus but no mention was made of the use of perioperative glycemic control or the preoperative glycated hemoglobin values between the groups. The use of other cardioprotective agents was poor; only 22% of patients received an angiotensin-converting enzyme (ACE) inhibitor and only 70% were on a b-blocker at the time of surgery. Cardiac catheterization data were not available at the time of the PCI so that the completeness of the revascularization performed during PCI for both groups was unknown. Nevertheless, this study is important in that it adds to previous reports showing that statins given before CABG and continued in the postoperative period resulted in significant decreases in 30-day mortality and MACE and increased long-term survival.7-10 Furthermore, these results are particularly important and impressive because all the patients in both groups received a statin 24 hours after surgery, which was then continued during the follow-up period. The fact that statins were particularly effective in those patients with prolonged crossclamp times and previous multivessel PCI suggests that these beneficial effects may have resulted from the decrease in the inflammatory response both acutely and in those patients with higher atherosclerotic burdens stemming from the pleiotropic effects of statins.11,12 These findings support the current guideline recommendations that all patients undergoing CABG should receive statin therapy to achieve a result that will reduce LDL-c levels to less than 100 mg/dL and less than 70 mg/dL in high-risk patients; and to achieve at least a 30% lowering of LDL-c levels in all patients.13 It also sends the important message to our medical colleagues that initiating and sustaining statin therapy after a PCI will significantly affect the results after future CABG surgery. Evidence is now emerging that statins are also beneficial to patients undergoing PCI. In a meta-analysis of 4805 patients undergoing PCI, statin therapy at the time of the procedure significantly reduced the incidence of periprocedural myocardial infarction (MI).14 In a review of 13 randomized studies involving 3341 patients undergoing PCI, the use of high-dose statin therapy reduced the risk of an MI or MACE by 44%.15 In a small study involving
The Journal of Thoracic and Cardiovascular Surgery c November 2014
Lazar
Editorial Commentary
171 PCI patients with acute coronary syndromes, atorvastatin significantly decreased the incidence of periprocedural MI and resulted in an 88% reduction in MACE.16 Chan and colleagues17 showed that statin therapy initiated at the time of PCI significantly reduced mortality at 30 days and at 6 months and that the mechanism was independent of any lowering of lipid levels.17 Several prospective randomized trials have also demonstrated that statin pretreatment with fixed doses of a specific statin provides significant cardioprotection during PCI.16,18,19 The favorable effects of statins may be related to their ability to decrease inflammatory processes, which are known to be increased during PCI.11 They have been shown to reduce C-reactive protein, improve endothelial function, and reduce platelet activation, which are all involved in the inflammatory response during PCI.12,20,21 In view of these advantages of statin therapy during and after PCI, why is the use of statin therapy in these patients not more common? Several explanations have been proposed: 1. Economic limitations: these drugs are expensive and may not be affordable or covered by all existing medical plans. 2. Physician philosophy: some primary care physicians are unlikely to begin statin therapy on patients with increase LDL-c levels if they are asymptomatic. 3. Patient issues: after a revascularization procedure, either a PCI or CABG, patients feel so much better and their angina is gone so that they no longer believe it is necessary to take extra medications and that their disease is cured. What can a surgeon do to make sure that patients remain on statin therapy after their CABG? This becomes important because in most practices, after surgery and at the initial postoperative visit, these patients are followed by cardiologists and primary care physicians whose role is to make sure that the guidelines for statin therapy after CABG are followed. This is especially crucial for those patients who undergo a PCI as their initial revascularization procedure and may not see a surgeon unless they require a CABG. In the past, surgeons have been reluctant to initiate statin therapy during the preoperative or postoperative period, believing that it was the responsibility of the cardiologist or referring physician to initiate lipid-lowering therapy. However, it is now well known that initiating statin therapy at the time of CABG or an acute coronary event not only decreases morbidity and mortality but it is more likely that patients will be more compliant with taking these medications in the long term. Muhlestein and colleagues22 found that patients who received a prescription for a statin on discharge from the hospital after an acute coronary event had better long-term compliance and reduced long-term mortality. In the Cardiac
Hospitalization Arterial Sclerosis Management Program (CHAMP), the initiation of statins, ACE inhibitors, aspirin, and b-blockers after an acute MI before hospital discharge increased the use of statins from 6% to 86% (P<.01).23 At the 1-year follow-up, compliance was 91% and 58% of CHAMP patients had an LDL-c level less than 100 mg/dL compared with only 6% of pre-CHAMP patients.24 This resulted in a significant reduction in the incidence of deaths, MIs, and repeat hospitalization over an 8-year period. Starting patients on statin therapy in the hospital after CABG surgery conveys the message to the patient that this is an important medication that may prevent another operation and prolong survival. I tell all my patients that they will need to be on a statin with a targeted level of less than 100 mg/dL, or less than 70 mg/dL if they have diabetes, for the rest of their lives. These data are sent to the referring cardiologist and primary care physician and are included in the discharge summary. We now know that revascularization alone is not sufficient to prevent recurrent ischemic events. By initiating statin therapy in all our patients undergoing CABG and educating them on the importance of targeted lipid therapy, we can provide them with the most optimal surgical as well as medical therapy to protect them from recurrent ischemic events. CONCLUSIONS Patients who have had a previous PCI and subsequently require CABG surgery have increased perioperative morbidity and mortality and decreased long-term survival. However, a study by Mannacio and colleagues6 has shown that patients who have received continuous statin therapy since their PCI have reduced risk for in-hospital and 2-year mortality compared with patients who did not receive statin therapy. References 1. Massoudi P, Thielman M, Lehmann N, Marr A, Kleikamp G, Malezka A, et al. Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multi-center analysis. J Thorac Cardiovasc Surg. 2009; 137:840-5. 2. Bonaros N, Hennerbichler V, Friedrich G, Kocher A, Pachinger O, Laufer G, et al. Increased mortality and perioperative complications in patients with previously elective percutaneous coronary interventions undergoing coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2009;137:846-52. 3. Tran HA, Barnett SD, Hunt SL, Chan A, Ad N. Effect of previous coronary artery stenting on short and intermediate term outcome after surgical revascularization in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2009;138:316-23. 4. Mannacio V, DiTommaso L, DeAmicis D, Lucchetti V, Pepino P, Musumeci F, et al. Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery. Ann Thorac Surg. 2012;93:1956-63. 5. Lazar HL. Detrimental effects of coronary stenting on subsequent coronary artery bypass surgery: is there another flag on the field. J Thorac Cardiovasc Surg. 2009;138:276-7. 6. Mannacio V, Meier P, Antignano A, Mottola M, Luigi DT, Musumeci F, et al. Continuative statin therapy after percutaneous coronary interventions improves outcome in coronary bypass surgery: a propensity score analysis of 2501 patients. J Thorac Cardiovasc Surg. 2014;148:1876-83. 7. Clark LL, Ikonomidis JS, Crawford FA, Crumbley A, Kratz JM, Stroud MR, et al. Perioperative statin therapy is associated with reduced postoperative mortality
The Journal of Thoracic and Cardiovascular Surgery c Volume 148, Number 5
1885
Editorial Commentary
8.
9.
10.
11.
12.
13.
14. 15.
16.
and morbidity in patients undergoing cardiac surgery: an eight year retrospective cohort study. J Thorac Cardiovasc Surg. 2006;131:679-85. Pan W, Dintar T, Anton J, Lee VV, Vaughn WK, Collard CD. Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. Circulation. 2004;110(Suppl II):II45-9. Dotani MI, Elnicki VM, Jain AC, Gibson CM. Effect of perioperative statin therapy in cardiac outcomes after coronary artery bypass grafting. Am J Cardiol. 2000;86:1128-30. Mannacio VA, Iorio V, DeAmicis V, DiLell F, Musumeci F. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial. J Thorac Cardiovasc Surg. 2008;136:1541-8. Gottsaunner-Wolf M, Zasmeta G, Hornykewycz S, Nikfardjam M, Stepan E, Wexberg P, et al. Plasma levels of c-reactive protein after coronary stent implantation. Eur Heart J. 2000;21:1152-8. Albert MA, Danielson E, Rifai N. Effects of statin therapy on c-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE). A randomized trial and cohort study. JAMA. 2001;286:64-70. Hillis D, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2001 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary. J Am Coll Cardiol. 2011;58:2584-614. Winchester DE, Wen X, Xie L, Baury AA. Evidence of pre-procedure statin therapy: a meta-analysis of randomized trials. J Am Coll Cardiol. 2010;56:1099-109. Patti G, Cannon CP, Murphy SA, Mega S, Pasceri V, Briguouri C, et al. Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies. Circulation. 2011;123:1622-32. Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti P, Sardell G, et al. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early coronary interventions: results of the ARMYVA-ACS randomized trial. J Am Coll Cardiol. 2007;49:1272-8.
1886
Lazar
17. Chan AW, Bhatt DL, Chu VP, Quinn MJ, Moliterno VJ. Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention. Circulation. 2002;195:691-6. 18. Pasceri V, Patti G, Nusca A, Priscipino C, Richichi G, DiSciasco G, ARMYVA investigators. A randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the Armada (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) study. Circulation. 2004;110:674-8. 19. Yun KH, Jeong Jong MH, Oh SK, Rhee SJ, Park EM, Li EM, et al. The beneficial effects of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol. 2009; 137:246-51. 20. Dupuis J, Tardif JC, Cernacek P. Cholesterol reduction rapidly improves endothelial function after acute coronary syndromes: the RECIFE (Reduction of Cholesterol in Ischemia and Function of the Endothelium) trial. Circulation. 1999;99:3227-33. 21. Keidar S, Aviram M, Maor I, Oiknine J, Brook JG. Pravastatin inhibits cellular cholesterol synthesis and increases low density lipoprotein receptor activity and macrophages: in vitro and in vivo studies. Br J Clin Pharmacol. 1994;38: 513-9. 22. Muhlestein JB, Horne BD, Blir TL. Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol. 2001;87:257-61. 23. Fonarow GC, Gawlinski A, Moughrabi S, Tillish JH. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001;87: 819-22. 24. Fonarow GC, Gawlinski A, Watson KA, Moughrabi S. Sustained improvement in treatment of Cardiovascular Hospitalization Atherosclerosis Management Program (CHAMP). Circulation. 2001;104:II-711.
The Journal of Thoracic and Cardiovascular Surgery c November 2014