Published online before print November 11, 2009, doi:10.1212/WNL.0b013e3181c677f6)
NEUROLOGY 2009;73:2099-2106
© 2009 American Academy of Neurology
Statin use and neurologic morbidity after coronary artery bypass grafting
A cohort study
M. A. Koenig, MD,
M. A. Grega, MSN,
M. M. Bailey, BA,
L. D. Pham, MS,
S. L. Zeger, PhD,
W. A. Baumgartner, MD and
G. M. McKhann, MD
From the Departments of Neurology (M.A.K.) and Surgery (M.A.G., W.A.B., G.M.M.), The Zanvyl Krieger Mind Brain Institute (M.M.B., G.M.M.), and Bloomberg School of Public Health (L.D.P., S.L.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD.
Address correspondence and reprint requests to Dr. Matthew Koenig, The Johns Hopkins Hospital, 600 N. Wolfe St., Meyer 8-140, Baltimore, MD 21287 mkoenin1{at}jhmi.edu
Background: Statin use before surgery has been associated with reduced morbidity and mortality after vascular surgery. The effect of preoperative statin use on stroke and encephalopathy after coronary artery bypass grafting (CABG) is unclear.
Methods: A post hoc analysis was undertaken of a prospectively collected cohort of isolated CABG patients over a 10-year period at a single institution. Primary outcomes were stroke and encephalopathy. Univariable analyses identified risk factors for statin use, which were applied to a propensity score model using logistic regression and patients were divided into quintiles of propensity for statin use. Controlling for propensity score quintile, the odds ratio (OR) of combined stroke and encephalopathy (primary endpoint), cardiovascular mortality, myocardial infarction, and length of stay were compared between statin users and nonusers.
Results: There were 5,121 CABG patients, of whom 2,788 (54%) were taking statin medications preoperatively. Stroke occurred in 166 (3.2%) and encephalopathy in 438 (8.6%), contributing to 604 patients (11.8%) who met the primary endpoint. The unadjusted OR of stroke/encephalopathy in statin users was 1.053 (95% confidence interval [CI] 0.888-1.248, p = 0.582). Adjustment based on propensity score resulted in balance of stroke risk factors among quintiles. The propensity score-adjusted OR of stroke/encephalopathy in statin users was 0.958 (95% CI 0.784-1.170, p = 0.674). There were no significant differences in cardiovascular mortality, myocardial infarction, or length of stay between statin users and otherwise similar nonusers.
Conclusions: In this large data cohort study, preoperative statin use was not associated with a decreased incidence of stroke and encephalopathy after coronary artery bypass grafting.
Abbreviations: ACE = angiotensin converting enzyme; ARB = angiotensin II receptor blocker; CABG = coronary artery bypass grafting; CI = confidence interval; MI = myocardial infarction; OR = odds ratio; PCI = percutaneous coronary intervention.
Editorial, page 2058
e-Pub ahead of print on November 11, 2009, at www.neurology.org.
Supported by grant 35610 from the National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, and by the Dana Foundation, New York, NY.
Disclosure: Author disclosures are provided at the end of the article.
Received February 3, 2009. Accepted in final form September 4, 2009.
Related Article
-
The quest for the "Holy Grail" of ischemic stroke cytoprotection: Statins may not be the answer
- Larry B. Goldstein and Jose I. Suarez
Neurology 2009 73: 2058-2059.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
L. B. Goldstein and J. I. Suarez
The quest for the "Holy Grail" of ischemic stroke cytoprotection: Statins may not be the answer
Neurology,
December 15, 2009;
73(24):
2058 - 2059.
[Full Text]
[PDF]
|
|
|
