The European Society of Anesthesiologists is meeting this week in Berlin, and one study of note that will be presented describes the effects of administering cardiovascular medications to patients undergoing coronary artery bypass graft (CABG).
CABG, known more commonly as coronary bypass surgery, is performed when a patient experiences a blockage or narrowing of the vessels that supply the heart with blood. The procedure diverts blood flow away from these vessels to ensure the heart muscles receive normal levels of oxygen and blood. An estimated 300,000 Americans receive this procedure annually. Giving cardiovascular medications preoperatively has long been practiced, however, previous studies have only looked at the efficacy of statins and not other commonly used cardiovascular medications.
This observational study, led by Dr. Robert Sanders of the University of Wisconsin - Madison and Drs. Puja Myles and Sudhir Venkatesan of the University of Nottingham, UK, analyzed data from over 16,000 patients, spanning 40 years. They reported that statins were the drug class CABG patients were on most commonly (85 percent of patients); next was beta blockers (73 percent), followed by ACE inhibitors (60 percent), calcium channel blockers (43 percent) and alpha-2 agonists (1 percent).
Using 5 statistical models and correcting for a variety of confounders (e.g. medications, comorbidities), the researchers found that as a group, statins were associated with a two thirds reduced risk of perioperative mortality. However, only simvastatin (the most commonly prescribed statin) were associated with a statistically significant protective effect, with a 77 percent reduction in mortality. No other medications studied were associated with a statistically significant protective effect.
The study s results suggest that all patients undergoing CABG should receive statins perioperatively; however the authors express caution when recommending which one. They explain: "In combination with previous studies, these data suggest that patients not taking statins should be considered for statin therapy based on their perioperative and chronic health risks. Consistent evidence of benefit or harm of the other drugs was not observed. Further data on the relative benefits of individual statin drugs are required -- however this study suggests that at least simvastatin offers protection."
