Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Impact of High-Dose Statin Pretreatment in Patients with Stable Angina during Off-Pump Coronary Artery Bypass

  • Youn, Young-Nam (Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Park, Seong-Yong (Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Hwang, Yoo-Hwa (Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Joo, Huyn-Chul (Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System) ;
  • Yoo, Kyung-Jong (Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System)
  • Received : 2011.02.17
  • Accepted : 2011.05.19
  • Published : 2011.06.05
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Abstract

Background: Periprocedural treatment with high-dose statins is known to have cardioprotective and pleiotropic effects, such as anti-thrombotic and anti-inflammatory actions. We aimed to assess the efficacy of high-dose rosuvastatin loading in patients with stable angina undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: A total of 142 patients with stable angina who were scheduled to undergo surgical myocardial revascularization were randomized to receive either pre-treatment with 60-mg rosuvastatin (rosuvastatin group, n=71) or no pre-treatment (control group, n=71) before OPCAB. The primary endpoint was the 30-day incidence of major adverse cardiac events (MACEs). The secondary endpoint was the change in the degree of myocardial ischemia as evaluated with creatine kinase-myocardial band (CK-MB) and troponin T (TnT). Results: There were no significant intergroup differences in preoperative risk factors or operative strategy. MACEs within 30 days after OPCAB occurred in one patient (1.4%) in the rosuvastatin group and four patients (5.6%) in the control group, respectively (p=0.37). Preoperative CK-MB and TnT were not different between the groups. After OPCAB, the mean maximum CK-MB was significantly higher in the control group (rosuvastatin group $10.7{\pm}9.75$ ng/mL, control group $14.6{\pm}12.9$ ng/mL, p=0.04). Furthermore, the mean levels of maximum TnT were significantly higher in the control group (rosuvastatin group $0.18{\pm}0.16$ ng/mL, control group $0.39{\pm}0.70$ ng/mL, p=0.02). Conclusion: Our findings suggest that high-dose rosuvastatin loading before OPCAB surgery did not result in a significant reduction of 30-day MACEs. However, high-dose rosuvastatin reduced myocardial ischemia after OPCAB.

Keywords

References

  1. Goldstein JL, Brown MS. Regulation of the mevalonate pathway. Nature 1990;343:425-30. https://doi.org/10.1038/343425a0
  2. Bernini F, Didoni G, Bonfadini G, Bellosta S, Fumagalli R. Requirement for mevalonate in acetylated LDL induction of cholesterol esterification in macrophages. Atherosclerosis 1993;104:19-26. https://doi.org/10.1016/0021-9150(93)90172-Q
  3. Corsini A, Mazzotti M, Raiteri M, et al. Relationship between mevalonate pathway and arterial myocyte proliferation: in vitro studies with inhibitors of HMG-CoA reductase. Atherosclerosis 1993;101:117-25. https://doi.org/10.1016/0021-9150(93)90107-6
  4. Grunler J, Ericsson J, Dallner G. Branch-point reactions in the biosynthesis of cholesterol, dolichol, ubiquinone and prenylated proteins. Biochimica et Biophysica Acta 1994;1212: 259-77. https://doi.org/10.1016/0005-2760(94)90200-3
  5. Corsini A, Raiteri M, Soma MR, Bernini F, Fumagalli R, Paoletti R. Pathogenesis of atherosclerosis and the role of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Am J Cardiol 1995;76:21A-8A. https://doi.org/10.1016/S0002-9149(05)80011-6
  6. Bellosta S, Ferri N, Arnaboldi L, Bernini F, Paoletti R, Corsini A. Pleiotropic effects of statins in atherosclerosis and diabetes. Diabetes Care 2000;23(Suppl 2):B72-8.
  7. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study. Circulation 2004;110:674-8. https://doi.org/10.1161/01.CIR.0000137828.06205.87
  8. Patti G, Chello M, Pasceri V, et al. Protection from procedural myocardial injury by atorvastatin is associated with lower levels of adhesion molecules after percutaneous coronary intervention: results from the ARMYDA-CAMs (Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Cell Adhesion Molecules) substudy. J Am Coll Cardiol 2006;48:1560-6.
  9. Patti G, Pasceri V, Colonna G, et al. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial. J Am Coll Cardiol 2007;49:1272-8. https://doi.org/10.1016/j.jacc.2007.02.025
  10. Poldermans D, Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation 2003;107:1848-51. https://doi.org/10.1161/01.CIR.0000066286.15621.98
  11. Pan W, Pintar 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:II45-9.
  12. Clark LL, Ikonomidis JS, Crawford FA Jr, et al. Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study. J Thorac Cardiovasc Surg 2006;131:679-85. https://doi.org/10.1016/j.jtcvs.2005.11.006
  13. Collard CD, Body SC, Shernan SK, Wang S, Mangano DT. Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2006;132:392-400. https://doi.org/10.1016/j.jtcvs.2006.04.009
  14. Youn YN, Kwak YL, Yoo KJ. Can the EuroSCORE predict the early and mid-term mortality after off-pump coronary artery bypass grafting? Ann Thorac Surg 2007;83:2111-7. https://doi.org/10.1016/j.athoracsur.2007.02.060
  15. Yang H, Youn YN, Yoo KJ. Correlation of akinesia with graft patency and cardiac enzyme after off-pump coronary artery bypass graft surgery. Circ J 2010;74:1564-9. https://doi.org/10.1253/circj.CJ-09-0857
  16. Vander Salm TJ, Kip KE, Jones RH, et al. What constitutes optimal surgical revascularization? Answers from the Bypass Angioplasty Revascularization Investigation (BARI). J Am Coll Cardiol 2002;39:565-72. https://doi.org/10.1016/S0735-1097(01)01806-X
  17. Sabik JF, Blackstone EH, Lytle BW, Houghtaling PL, Gillinov AM, Cosgrove DM. Equivalent midterm outcomes after off-pump and on-pump coronary surgery. J Thorac Cardiovasc Surg 2004;127:142-8. https://doi.org/10.1016/j.jtcvs.2003.08.046
  18. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. J Am Coll Cardiol 2007;50:2173-95. https://doi.org/10.1016/j.jacc.2007.09.011
  19. Powell BD, Bybee KA, Valeti U, et al. Influence of preoperative lipid-lowering therapy on postoperative outcome in patients undergoing coronary artery bypass grafting. Am J Cardiol 2007;99:785-9. https://doi.org/10.1016/j.amjcard.2006.10.036
  20. Song YB, On YK, Kim JH, et al. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. Am Heart J 2008;156:373 e9-16. https://doi.org/10.1016/j.ahj.2008.04.020
  21. Winchester DE, Wen X, Xie L, Bavry AA. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol 2010;56:1099-109. https://doi.org/10.1016/j.jacc.2010.04.023
  22. Wassmann S, Faul A, Hennen B, Scheller B, Bohm M, Nickenig G. Rapid effect of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition on coronary endothelial function. Circ Res 2003;93:e98-103. https://doi.org/10.1161/01.RES.0000099503.13312.7B
  23. Hinoi T, Matsuo S, Tadehara F, Tsujiyama S, Yamakido M. Acute effect of atorvastatin on coronary circulation measured by transthoracic Doppler echocardiography in patients without coronary artery disease by angiography. Am J Cardiol 2005;96:89-91.
  24. Ray KK, Cannon CP. Early time to benefit with intensive statin treatment: could it be the pleiotropic effects? Am J Cardiol 2005;96:54F-60F. https://doi.org/10.1016/j.amjcard.2005.06.027

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