Preoperative Statin Therapy and Surgical Outcomes in Patients with Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting: A Report from the North-Rhine-Westphalia Surgical Myocardial Infarction Registry

Objectives: To evaluate whether preoperative statin therapy is associated with a dose-dependent reduction in hospital mortality and major adverse cardiac events (MACE) in patients referred to coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). Methods: Between 01/2010 and 05/2012 a total of 1151 patients undergoing urgent CABG for ACS were prospectively entered into the North-Rhine-Westphalia surgical myocardial infarction registry and subdivided into three groups according to their preoperative statin medication: no statins, normal or high statin dose. After univariate analysis a multivariate logistic regression model (MVA) was employed to identify predictors for in-hospital mortality and MACE (mortality, myocardial infarction, low-cardiac-output-failure). Results: Pre- and intraoperative data of statin naive patients (n = 208; 18%) and patients receiving low (n = 521, 45%) or high-dose statin therapy (n = 422, 37%) did not differ (mean age 68 ± 11yrs, males 78%, log.EuroSCORE 24 ± 21%, three-vessel-disease 80%, main-stem involvement 46%, CPB-time 103 ± 43 minute). Statin naive patients where more often referred for STEMI (31%) and less often for unstable angina (16%) compared with statin treated patients (p < 0.05). In-hospital mortality and MACE rate was significantly higher in statin naive patients (12.5% and 22.1%) when compared with the low (5.6% and 8.1%) or high-dose statin group (7.1% and 11.6%,p < 0.05 versus no statins). MVA revealed that both, low and high-dose statin therapy before CABG for ACS, was independently predictive for lower in-hospital mortality and MACE (p < 0.01). Conclusions: Preoperative statin therapy in patients with ACS undergoing CABG is associated to a significant reduction in postoperative mortality and MACE in a dose-independent manner.