BioMed research international · 2018
Efficacy of Statin Therapy Related to Baseline Renal Function in Patients with Rheumatic Heart Disease Undergoing Cardiac Surgery.
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Zou Rongjun, Shi Wanting, Tao Jun, Lin Xifeng, Zhang Dingwen, Yang Songran, Hua Ping
Аннотация
BACKGROUND: Renal impairment increases the risk of cardiovascular events and perioperative complications in patients with heart valve disease. This study aimed to determine the perioperative benefit of statin treatment related to baseline renal function in patients with rheumatic heart disease (RHD) who had cardiac surgery.
METHODS AND RESULTS: We performed a retrospective study on 136 patients with RHD who underwent valve replacement surgery. The mean age of the patients was 56.2 years, 59.6% were female, 8.8% patients had diabetes mellitus, and 27.2% of patients had hypertension. Overall, 3 patients died, 2 underwent reoperation, and 25 underwent thoracentesis during the study period. For patients with renal impairment, there was a higher risk of thoracic puncture (odds ratio [OR]: 3.33; 95% confidence interval [CI]: 1.36, 8.11; P < 0.01) and a longer time of drainage (difference in means: 1; 95% CI: 0.88, 1.12; P < 0.01), intensive care unit (ICU) stay (difference in means: 0.2; 95% CI: 0.17, 0.23; P = 0.02), and hospital stay (difference in means: 6.6; 95% CI: 6.15, 7.05; P < 0.01) compared with normal renal function. Furthermore, statins were associated with a reduction in drainage time (difference in means: -1.50; 95% CI: -1.86, -1.14; P = 0.02), ICU stay (difference in means: -0.30; 95% CI: -0.40, -0.20; P = 0.05), and hospital stay (difference in means: -5.40; 95% CI: -6.57, -4.23; P < 0.01) in patients with renal impairment (interaction, P ≤ 0.05 for all), but not in those with normal renal function.
CONCLUSION: Statins have a greater clinical benefit in perioperative cardiac surgery with renal impairment. Statins are associated with a comparatively lower risk of thoracic puncture, as well as a reduced trend toward a reduction in drainage time, ICU stay, and hospital stay.
METHODS AND RESULTS: We performed a retrospective study on 136 patients with RHD who underwent valve replacement surgery. The mean age of the patients was 56.2 years, 59.6% were female, 8.8% patients had diabetes mellitus, and 27.2% of patients had hypertension. Overall, 3 patients died, 2 underwent reoperation, and 25 underwent thoracentesis during the study period. For patients with renal impairment, there was a higher risk of thoracic puncture (odds ratio [OR]: 3.33; 95% confidence interval [CI]: 1.36, 8.11; P < 0.01) and a longer time of drainage (difference in means: 1; 95% CI: 0.88, 1.12; P < 0.01), intensive care unit (ICU) stay (difference in means: 0.2; 95% CI: 0.17, 0.23; P = 0.02), and hospital stay (difference in means: 6.6; 95% CI: 6.15, 7.05; P < 0.01) compared with normal renal function. Furthermore, statins were associated with a reduction in drainage time (difference in means: -1.50; 95% CI: -1.86, -1.14; P = 0.02), ICU stay (difference in means: -0.30; 95% CI: -0.40, -0.20; P = 0.05), and hospital stay (difference in means: -5.40; 95% CI: -6.57, -4.23; P < 0.01) in patients with renal impairment (interaction, P ≤ 0.05 for all), but not in those with normal renal function.
CONCLUSION: Statins have a greater clinical benefit in perioperative cardiac surgery with renal impairment. Statins are associated with a comparatively lower risk of thoracic puncture, as well as a reduced trend toward a reduction in drainage time, ICU stay, and hospital stay.