TY - JOUR
T1 - Statins for secondary prevention and major adverse events after coronary artery bypass grafting
AU - Pan, Emily
AU - Nielsen, Susanne J.
AU - Mennander, Ari
AU - Björklund, Erik
AU - Martinsson, Andreas
AU - Lindgren, Martin
AU - Hansson, Emma C.
AU - Pivodic, Aldina
AU - Jeppsson, Anders
N1 - Funding Information:
This work was supported by grants from the Swedish Heart-Lung Foundation (20180560 to A.J. and 201604 to S.J.N.), the Swedish state under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement; ALFGBG-725131 to A.J.), and V?stra G?taland Region (VGFOUREG-847811 and VGFOUREG-665591 to A.J.), and Family Nils Winberg's Foundation. The supporting bodies had no influence on the analysis and interpretation of data, on the writing of the report, or on the decision to submit the report for publication.
Funding Information:
This work was supported by grants from the Swedish Heart-Lung Foundation ( 20180560 to A.J. and 201604 to S.J.N.), the Swedish state under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement; ALFGBG-725131 to A.J.), and Västra Götaland Region ( VGFOUREG-847811 and VGFOUREG-665591 to A.J.), and Family Nils Winberg’s Foundation . The supporting bodies had no influence on the analysis and interpretation of data, on the writing of the report, or on the decision to submit the report for publication.
PY - 2022/12
Y1 - 2022/12
N2 - Objective: The objective of this study was to evaluate the association of statin use after coronary artery bypass grafting (CABG) and long-term adverse events in a large population-based, nationwide cohort. Methods: All 35,193 patients who underwent first-time isolated CABG in Sweden from 2006 to 2017 and survived at least 6 months after surgery were included. Individual patient data from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and 4 other nationwide registries were merged. Multivariable Cox regression models adjusted for age, sex, comorbidities, and time-updated treatment with other secondary preventive medications were used to evaluate the associations between statin treatment and outcomes. The primary end point was major adverse cardiovascular events (MACE). Median follow-up time to MACE was 5.3 (interquartile range, 2.5-8.2) years. Results: Statins were dispensed to 95.7% of the patients six months after discharge and to 78.9% after 10 years. At baseline, 1.4% of patients were prescribed low-, 57.6% intermediate-, and 36.7% high-dose statins. Ongoing statin treatment was associated with markedly reduced risk of MACE (adjusted hazard ratio [aHR], 0.56 [95% CI, 0.53-0.59]), all-cause mortality (aHR, 0.53 [95% CI, 0.50-0.56]), cardiovascular death (aHR, 0.54 [95% CI, 0.50-0.59]), myocardial infarction (aHR, 0.61 [95% CI, 0.55-0.69]), stroke (aHR, 0.66 [95% CI, 0.59-0.73]), new revascularization (aHR, 0.79 [95% CI, 0.70-0.88]), new angiography (aHR, 0.81 [95% CI, 0.74-0.88]), and dementia (aHR, 0.74 [95% CI, 0.65-0.85]; all P <.01), irrespective of the statin dose. Conclusions: Ongoing statin use was associated with a markedly reduced incidence of adverse events and mortality after CABG. Initiating and maintaining statin medication is essential in CABG patients.
AB - Objective: The objective of this study was to evaluate the association of statin use after coronary artery bypass grafting (CABG) and long-term adverse events in a large population-based, nationwide cohort. Methods: All 35,193 patients who underwent first-time isolated CABG in Sweden from 2006 to 2017 and survived at least 6 months after surgery were included. Individual patient data from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and 4 other nationwide registries were merged. Multivariable Cox regression models adjusted for age, sex, comorbidities, and time-updated treatment with other secondary preventive medications were used to evaluate the associations between statin treatment and outcomes. The primary end point was major adverse cardiovascular events (MACE). Median follow-up time to MACE was 5.3 (interquartile range, 2.5-8.2) years. Results: Statins were dispensed to 95.7% of the patients six months after discharge and to 78.9% after 10 years. At baseline, 1.4% of patients were prescribed low-, 57.6% intermediate-, and 36.7% high-dose statins. Ongoing statin treatment was associated with markedly reduced risk of MACE (adjusted hazard ratio [aHR], 0.56 [95% CI, 0.53-0.59]), all-cause mortality (aHR, 0.53 [95% CI, 0.50-0.56]), cardiovascular death (aHR, 0.54 [95% CI, 0.50-0.59]), myocardial infarction (aHR, 0.61 [95% CI, 0.55-0.69]), stroke (aHR, 0.66 [95% CI, 0.59-0.73]), new revascularization (aHR, 0.79 [95% CI, 0.70-0.88]), new angiography (aHR, 0.81 [95% CI, 0.74-0.88]), and dementia (aHR, 0.74 [95% CI, 0.65-0.85]; all P <.01), irrespective of the statin dose. Conclusions: Ongoing statin use was associated with a markedly reduced incidence of adverse events and mortality after CABG. Initiating and maintaining statin medication is essential in CABG patients.
KW - coronary artery bypass grafting
KW - outcome
KW - secondary prevention medication
KW - statin
U2 - 10.1016/j.jtcvs.2021.08.088
DO - 10.1016/j.jtcvs.2021.08.088
M3 - Article
AN - SCOPUS:85116023812
SN - 0022-5223
VL - 164
SP - 1875-1886.e4
JO - JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
JF - JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
IS - 6
ER -