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1: Circulation. 2008 Oct 28;118(18):1785-92. Epub 2008 Oct 13.
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Impact of statin use on outcomes after coronary artery bypass graft surgery.

Kulik A, Brookhart MA, Levin R, Ruel M, Solomon DH, Choudhry NK.

Brigham and Women's Hospital, 1620 Tremont St, Suite 3030, Boston, MA 02120, USA.

BACKGROUND: The benefits of statins have been demonstrated for patients with a remote history of coronary artery bypass grafting (CABG); however, no investigation to date has evaluated whether initiation of statin therapy in the early months after surgery improves clinical outcomes. METHODS AND RESULTS: A retrospective cohort of 7503 Medicare patients >/=65 years of age who underwent CABG (1995-2003) was assembled by use of linked hospital and pharmacy claims data. Rates of all-cause mortality and major adverse cardiovascular events were compared between patients who were (n=1745) and were not (n=5788) prescribed statins within 1 month of CABG discharge. Additional analyses evaluated the impact of statin initiation between 1 and 6 months after surgery. Multivariable and propensity score analysis demonstrated that statin use within 1 month of CABG discharge independently reduced the risk of all-cause mortality (adjusted hazard ratio 0.82, 95% confidence interval 0.72 to 0.94) compared with no statin use. Similarly, statin use within 1 month of CABG discharge independently reduced the risk of major adverse cardiovascular events (adjusted hazard ratio 0.89, 95% confidence interval 0.81 to 0.98). Initiation of statin therapy between 1 and 6 months after CABG discharge was also associated with reductions in major adverse cardiovascular events and mortality; however, outcome rates between early (</=1 month after CABG) and delayed (1 to 6 months after CABG) statin initiation were not significantly different. CONCLUSIONS: Statin therapy initiated in the early months after hospital discharge independently reduces all-cause mortality and major adverse cardiovascular events after CABG. These findings validate the widespread practice of prescribing long-term statin therapy after CABG.

PMID: 18852363 [PubMed - indexed for MEDLINE]