Shklianka I. The effectiveness of statins in patients with stable coronary heart disease during myocardium surgical revascularization

The study includes the data from 155 patients with stable coronary heart disease consecutively selected for isolated coronary artery bypass graft surgery (CABG). The study did not include patients during the first 28 days after acute coronary syndromes and those scheduled for combined operations (CABG in combination with valve replacement surgery). Evaluating the efficacy of perioperative use of statins in the study, it was found that the absence of statin therapy was associated with more frequent postoperative complications (postoperative atrial fibrillation (AF), acute myocardial infarction (MI) and acute heart failure) compared to statins in moderate and high doses (73% versus 36% and 28% of patients in clinical groups, respectively). In our study, in total 84 early postoperative complications (EPOC) were registered in 66 patients. Most of the EPOC (56%) were the cases of postoperative atrial fibrillation- flutter. According to the results of a univariate regression analysis the absence of perioperative statins therapy, the degree of diabetes mellitus, the number of implanted shunts and the degree of left ventricular hypertrophy were associated with the occurrence of EPOC. According to the multivariate analysis, the risk of EPOC after CABG was 2.5 times higher among patients who did not take statins in the perioperative period, compared to patients who received moderate or high-intensity statins for >=7 days. In patients with severe diabetes, the risk of EPOC was 1.96 times higher than in patients with mild diabetes. According to a univariate regression analysis, the following indicators were associated with the occurrence of LE: AF in history, larger left atrium size, lower glomerular filtation rate (GFR) for discharge, higher end-diastolic volume index for discharge, lower LV EF for discharge, post-operative use of aldosterone antagonists and loop diuretics, absence of statin therapy. According to the multivariate analysis, the independent predictors of LE after CABG were the worst GFR at discharge (OR 1,366 (95%CI 1,007-1,853), p = 0.045), postoperative use of loop diuretics (OR 2,186 (95% CI 1,187-4,024), p = 0.012) and the absence of postoperative statin therapy (OR 6,236 (95% CI 2,313-16,809), p <0.001).