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Journal of Cardiothoracic Surgery

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Open Access 01-12-2017 | Research article

High dose statin prophylaxis in cardiopulmonary bypass related surgery: clinical utility

Authors: Yie Roei Chee, R William G Watson, James McCarthy, Jehan Zeb Chughtai, Lars Nölke, David G Healy

Published in: Journal of Cardiothoracic Surgery | Issue 1/2017

Abstract

Background

Previous studies from our group demonstrated the anti-inflammatory properties of statins on cardiopulmonary bypass (CPB), through inhibition of neutrophil transendothelial migration. We sought to determine the utility of preoperative statin on patients undergoing cardiac surgery, to investigate any moderating effects on the systemic inflammatory response (SIRS) with CPB, and to evaluate any clinical impact on our patients.

Methods

This is a prospective, randomised controlled trial with national regulatory body approval. Eligible patients were already on oral statin therapy. They were then randomly assigned to either investigation arm (n = 15, atorvastatin 80 mg for 2 weeks before surgery) or control arm (n = 15, no change to current statin therapy). Blood and urine samples were collected at 3 timepoints. Postoperative clinical measures were documented.

Results

Patients in the investigation arm have significantly lower troponin level (p = 0.016), and lower level of urine neutrophil gelatinase-associated lipocalin (NGAL; p = 0.002); thus demonstrating a lesser degree of cardiac and renal injury in these patients. Higher level of Interleukin-8 (IL-8) at baseline (p = 0.036) and 4 h post cross-clamp removal (p = 0.035) in the investiation arm. A similar trend is also observed in Matrix Metalloproteinase-9 (MMP-9; p > 0.05). There were however no differences in clinical outcomes.

Conclusions

Maximizing the dose of statin in patients waiting for cardiac surgery has measurable biological effects. There is evidence of less cardiac and renal damage. The use of preoperative statins and in particular, high dose preoperative statin therapy, may prove a useful new tool for optimal preparation of patients for cardiac surgery.

Trial registration

EudraCT no. 2012-003396-20. Registered 05 November 2012

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Title: High dose statin prophylaxis in cardiopulmonary bypass related surgery: clinical utility
Authors: Yie Roei Chee
R William G Watson
James McCarthy
Jehan Zeb Chughtai
Lars Nölke
David G Healy
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2017
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-017-0582-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

High dose statin prophylaxis in cardiopulmonary bypass related surgery: clinical utility

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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