Effect of Lipid-lowering Medications in Patients With Coronary Artery Bypass Grafting Surgery Outcomes

Chunxia Shi; Zugui Zhang; Jordan Goldhammer; David Li; Bob Kiaii; Victor Rudriguez; Douglas Boyd; David Lubarsky; Richard Applegate; Hong Liu

Disclosures

BMC Anesthesiol. 2022;22(122)

Abstract and Introduction

Abstract

Background: Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

Methods: After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated

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Abstract and Introduction
Methods
Results
Discussion
References

Table 1. Demographics and clinical characteristics of study cohort
Characteristics	Non-LLT Group	LLT Group	p-value	PS adjusted Non-LLT	PS adjusted LLT	p-value
Age(years), Mean [SD]	65.5(12.1)	66.4(10.7)	0.231	66.4(11.3)	66.0(10.8)	0.394
Female, N (%)	225(29.5)	778(24.1)	0.003	1060(26.1)	1002(25.2)	0.637
BMI, Mean [SD]	28.7(8.4)	29.5(7.5)	0.007	29.1(5.9)	29.2(5.9)	0.778
Diabetes, N (%)	231(30.2)	1361(42.2)	< 0.001	1675(41.3)	1593(40.0)	0.591
Renal Failure, N (%)	47(6.2)	169(5.2)	0.363	211(5.2)	214(5.4)	0.861
Dialysis, N (%)	32(4.2)	120(3.7)	0.617	151(3.7)	151(3.8)	0.943
Hypertension, N (%)	556(72.8)	2755(85.5)	< 0.001	3378(83.3)	3308(83.1)	0.896
Smoking, N (%)	359(47.0)	1645(51.0)	0.049	2025(49.9)	1993(50.0)	0.957
Chronic lung disease, N (%)	132(17.3)	532(16.5)	0.643	631(15.6)	660(16.6)	0.539
Peripheral arterial disease, N (%)	87(11.4)	497(15.4)	0.006	636(15.7)	584(14.7)	0.593
Cerebrovascular disease, N (%)	91(11.9)	587(18.2)	< 0.001	720(17.8)	678(17.0)	0.717
Creatinine, Mean [SD]	1.26(1.16)	1.23(1.04)	0.523	1.24(1.06)	1.23(1.07)	0.885
Previous cardiac surgery, N (%)	17(2.2)	139(4.3)	0.010	177(4.4)	157(3.9)	0.718
Previous MI, N (%)	253(33.1)	1482(46.0)	< 0.001	1763(43.4)	1728(43.4)	0.985
Previous heart failure, N (%)	206(27.0)	811(25.2)	0.325	1007(24.8)	1009(25.3)	0.792
Cardiogenic shock, N (%)	25(3.3)	51(1.6)	0.003	75(1.8)	75(1.9)	0.942
ACEI. ARB treatment, N (%)	297(38.9)	1568(48.6)	< 0.001	1986(48.9)	1872(47.0)	0.410
Aspirin treatment, N (%)	547(71.6)	2853(88.5)	< 0.001	3500(86.3)	3403(85.5)	0.519
β-blocker treatment, N (%)	485(63.5)	2573(79.8)	< 0.001	3136(77.3)	3058(76.8)	0.776
EF <, Mean [SD]	50.2(14.49)	51.03(13.62)	0.132	51.1(13.3)	50.9(13.8)	0.719
Valve procedure, N (%)	239(31.3)	705(21.9)	< 0.001	911(22.4)	938.2(23.6)	0.536
Other cardiac surgery, N (%)	85(11.1)	273(8.5)	0.025	325(8.0)	353(8.9)	0.449
CPB time, Mean [SD]	136.7(78.9)	132.0(71.4)	0.109	134.2(76.6)	132.7(72.1)	0.685
Clamp time, Mean [SD]	97.6(61.8)	92.7(54.5)	0.028	94.8(61.2)	93.2(54.9)	0.583

LLT lipid lowing treatment, N numbers, SD standard deviation, BMI body mass index, MI myocardial infarction, EF ejection fraction, CPB cardiopulmonary bypass, DC-lipid lowering discharge with lipid lowering medications, PS propensity score

Table 2. Effect of lipid-lowering medications on outcomes
Outcome	Non-LLT Group	LLT Group	P value	PS adjusted Non-LLT	PS adjusted LLT	P value
In-hospital complications, N (%)	300(39.3)	1086(33.7)	0.004	1508.9(37.2)	1339.8(33.6)	0.109
Infection, N (%)	8(0.9)	40(1.2)	0.493	38.3(0.9)	45.9(1.2)	0.639
Stroke, N (%)	21(2.7)	48(1.5)	0.025	123.9(3.1)	59.4(1.5)	0.016
Other neurologic complications, N (%)	29(3.8)	76(2.4)	0.035	163.1(4.0)	93.3(2.3)	0.033
Ventilation prolong, N (%)	129(16.9)	453(14.1)	0.053	623.7(15.4)	567.5(14.3)	0.495
Renal failure, N (%)	29(3.8)	133(4.1)	0.754	169.9(4.2)	165.1(4.1)	0.964
Renal dialysis, N (%)	11(1.4)	64(2.0)	0.396	65.5(1.6)	79.8(2.0)	0.563
New onset AF, N (%)	192(25.1)	797(24.7)	0.850	979.9(24.2)	979.4(24.6)	0.824
Total ICU hours, Mean [17]	121.9(343.1)	102.6(156.2)	0.020	116.7(305.3)	103.7(158.2)	0.685
Length of hospital stay, Mean [17]	9.30(8.49)	9.39(35.73)	0.947	8.87(7.66)	9.36(33.24)	0.430
In-hospital Mortality, N (%)	13(1.7)	39(1.2)	0.368	84.5(2.1)	51.1(1.3)	0.213
30d Mortality, N (%)	15(2.0)	49(1.5)	0.473	79.8(2.0)	62.1(1.6)	0.539
Overall Mortality, N (%)	111(14.5)	361(11.2)	0.012	606.2(14.9)	448.9(11.3)	0.017

LLT lipid lowing treatment, N numbers, SD standard deviation, AF atrial fibrillation, PS propensity score

Table 3. Association between lipid-lowering treatment and postoperative complication and mortality after propensity weighted risk-adjustment
Outcomes	OR	Coefficient	95%CI	P value
In-hospital complication	0.856		0.781–0.938	< 0.001
Infection	1.223		0.795–1.890	0.361
Stroke	0.481		0.349–0.654	< 0.001
Neurologic complication	0.572		0.441–0.739	< 0.001
Ventilation prolonged	0.915		0.809–1.-35	0.156
Renal failure	0.989		0.795–1.232	0.922
Renal dialysis	1.245		0.896–1.736	0.192
New onset AF	1.024		0.925–1.134	0.645
In-hospital Mortality	0.616		0.432–0.869	0.006
30-day Mortality	0.789		0.563–1.101	0.165
Overall Mortality	0.723		0.634–0.824	< 0.001
Total ICU hours		-12.985	-28.120–2.150	0.093
Length of hospital stay		0.491	-1.000–1.983	0.518