Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery

Harm H H Feringa; Olaf Schouten; Stefanos E Karagiannis; Jasper Brugts; Abdou Elhendy; Eric Boersma; Radosav Vidakovic; Marc R H M van Sambeek; Peter G Noordzij; Jeroen J Bax; Don Poldermans

doi:10.1016/j.jacc.2007.06.046

Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery

Harm H H Feringa, Olaf Schouten, Stefanos E Karagiannis, Jasper Brugts, Abdou Elhendy, Eric Boersma, Radosav Vidakovic, Marc R H M van Sambeek, Peter G Noordzij, Jeroen J Bax, Don Poldermans^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: This study sought to examine whether higher statin doses and lower low-density lipoprotein (LDL) cholesterol are associated with improved cardiac outcome in vascular surgery patients.

BACKGROUND: Statins may have cardioprotective effects during major vascular surgery.

METHODS: In a prospective study of 359 vascular surgery patients, statin dose and cholesterol levels were recorded preoperatively. Myocardial ischemia and heart rate variability were assessed by 72-h 12-lead electrocardiography starting 1 day before to 2 days after surgery. Troponin T was measured on postoperative day 1, 3, 7, and before discharge. Cardiac events included cardiac death or nonfatal Q-wave myocardial infarction at 30 days and follow-up (mean 2.3 years).

RESULTS: Perioperative myocardial ischemia, troponin T release, 30-day events, and late cardiac events occurred in 29%, 23%, 4%, and 18%, respectively. In multivariate analysis, lower LDL cholesterol (per 10 mg/dl) correlated with lower myocardial ischemia (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80 to 0.95), troponin T release (OR 0.89, 95% CI 0.82 to 0.96), and 30-day (OR 0.89, 95% CI 0.78 to 1.00) and late cardiac events (hazard ratio 0.91, 95% CI 0.84 to 0.96). Higher statin doses (per 10% of maximum recommended dose) correlated with lower myocardial ischemia (OR 0.85, 95% CI 0.76 to 0.93), troponin T release (OR 0.84, 95% CI 0.76 to 0.93), and 30-day (OR 0.62, 95% CI 0.40 to 0.96) and late cardiac events (hazard ratio 0.76, 95% CI 0.65 to 0.89), even after adjusting for LDL cholesterol. Significantly higher perioperative heart rate variability was observed in patients with higher statin doses.

CONCLUSIONS: Higher statin doses and lower LDL cholesterol correlate with lower perioperative myocardial ischemia, perioperative troponin T release, and 30-day and late cardiac events in major vascular surgery.

Original language	English
Pages (from-to)	1649-1956
Number of pages	8
Journal	Journal of the American College of Cardiology
Volume	50
Issue number	17
DOIs	https://doi.org/10.1016/j.jacc.2007.06.046
Publication status	Published - 23 Oct 2007
Externally published	Yes

Keywords

Aged
Biomarkers/metabolism
Cholesterol, LDL/drug effects
Dose-Response Relationship, Drug
Female
Heart Rate/drug effects
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage
Male
Multivariate Analysis
Myocardial Ischemia/diagnosis
Outcome Assessment, Health Care
Prospective Studies
Troponin T/drug effects
Vascular Surgical Procedures

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10.1016/j.jacc.2007.06.046

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Feringa, H. H. H., Schouten, O., Karagiannis, S. E., Brugts, J., Elhendy, A., Boersma, E., Vidakovic, R., van Sambeek, M. R. H. M., Noordzij, P. G., Bax, J. J., & Poldermans, D. (2007). Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery. Journal of the American College of Cardiology, 50(17), 1649-1956. https://doi.org/10.1016/j.jacc.2007.06.046

@article{5434d775d1ad44679f5d45d1df7ccdbf,

title = "Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery",

abstract = "OBJECTIVES: This study sought to examine whether higher statin doses and lower low-density lipoprotein (LDL) cholesterol are associated with improved cardiac outcome in vascular surgery patients.BACKGROUND: Statins may have cardioprotective effects during major vascular surgery.METHODS: In a prospective study of 359 vascular surgery patients, statin dose and cholesterol levels were recorded preoperatively. Myocardial ischemia and heart rate variability were assessed by 72-h 12-lead electrocardiography starting 1 day before to 2 days after surgery. Troponin T was measured on postoperative day 1, 3, 7, and before discharge. Cardiac events included cardiac death or nonfatal Q-wave myocardial infarction at 30 days and follow-up (mean 2.3 years).RESULTS: Perioperative myocardial ischemia, troponin T release, 30-day events, and late cardiac events occurred in 29%, 23%, 4%, and 18%, respectively. In multivariate analysis, lower LDL cholesterol (per 10 mg/dl) correlated with lower myocardial ischemia (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80 to 0.95), troponin T release (OR 0.89, 95% CI 0.82 to 0.96), and 30-day (OR 0.89, 95% CI 0.78 to 1.00) and late cardiac events (hazard ratio 0.91, 95% CI 0.84 to 0.96). Higher statin doses (per 10% of maximum recommended dose) correlated with lower myocardial ischemia (OR 0.85, 95% CI 0.76 to 0.93), troponin T release (OR 0.84, 95% CI 0.76 to 0.93), and 30-day (OR 0.62, 95% CI 0.40 to 0.96) and late cardiac events (hazard ratio 0.76, 95% CI 0.65 to 0.89), even after adjusting for LDL cholesterol. Significantly higher perioperative heart rate variability was observed in patients with higher statin doses.CONCLUSIONS: Higher statin doses and lower LDL cholesterol correlate with lower perioperative myocardial ischemia, perioperative troponin T release, and 30-day and late cardiac events in major vascular surgery.",

keywords = "Aged, Biomarkers/metabolism, Cholesterol, LDL/drug effects, Dose-Response Relationship, Drug, Female, Heart Rate/drug effects, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage, Male, Multivariate Analysis, Myocardial Ischemia/diagnosis, Outcome Assessment, Health Care, Prospective Studies, Troponin T/drug effects, Vascular Surgical Procedures",

author = "Feringa, {Harm H H} and Olaf Schouten and Karagiannis, {Stefanos E} and Jasper Brugts and Abdou Elhendy and Eric Boersma and Radosav Vidakovic and {van Sambeek}, {Marc R H M} and Noordzij, {Peter G} and Bax, {Jeroen J} and Don Poldermans",

year = "2007",

month = oct,

day = "23",

doi = "10.1016/j.jacc.2007.06.046",

language = "English",

volume = "50",

pages = "1649--1956",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "17",

}

Feringa, HHH, Schouten, O, Karagiannis, SE, Brugts, J, Elhendy, A, Boersma, E, Vidakovic, R, van Sambeek, MRHM, Noordzij, PG, Bax, JJ & Poldermans, D 2007, 'Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery', Journal of the American College of Cardiology, vol. 50, no. 17, pp. 1649-1956. https://doi.org/10.1016/j.jacc.2007.06.046

Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery. / Feringa, Harm H H; Schouten, Olaf; Karagiannis, Stefanos E et al.
In: Journal of the American College of Cardiology, Vol. 50, No. 17, 23.10.2007, p. 1649-1956.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery

AU - Feringa, Harm H H

AU - Schouten, Olaf

AU - Karagiannis, Stefanos E

AU - Brugts, Jasper

AU - Elhendy, Abdou

AU - Boersma, Eric

AU - Vidakovic, Radosav

AU - van Sambeek, Marc R H M

AU - Noordzij, Peter G

AU - Bax, Jeroen J

AU - Poldermans, Don

PY - 2007/10/23

Y1 - 2007/10/23

N2 - OBJECTIVES: This study sought to examine whether higher statin doses and lower low-density lipoprotein (LDL) cholesterol are associated with improved cardiac outcome in vascular surgery patients.BACKGROUND: Statins may have cardioprotective effects during major vascular surgery.METHODS: In a prospective study of 359 vascular surgery patients, statin dose and cholesterol levels were recorded preoperatively. Myocardial ischemia and heart rate variability were assessed by 72-h 12-lead electrocardiography starting 1 day before to 2 days after surgery. Troponin T was measured on postoperative day 1, 3, 7, and before discharge. Cardiac events included cardiac death or nonfatal Q-wave myocardial infarction at 30 days and follow-up (mean 2.3 years).RESULTS: Perioperative myocardial ischemia, troponin T release, 30-day events, and late cardiac events occurred in 29%, 23%, 4%, and 18%, respectively. In multivariate analysis, lower LDL cholesterol (per 10 mg/dl) correlated with lower myocardial ischemia (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80 to 0.95), troponin T release (OR 0.89, 95% CI 0.82 to 0.96), and 30-day (OR 0.89, 95% CI 0.78 to 1.00) and late cardiac events (hazard ratio 0.91, 95% CI 0.84 to 0.96). Higher statin doses (per 10% of maximum recommended dose) correlated with lower myocardial ischemia (OR 0.85, 95% CI 0.76 to 0.93), troponin T release (OR 0.84, 95% CI 0.76 to 0.93), and 30-day (OR 0.62, 95% CI 0.40 to 0.96) and late cardiac events (hazard ratio 0.76, 95% CI 0.65 to 0.89), even after adjusting for LDL cholesterol. Significantly higher perioperative heart rate variability was observed in patients with higher statin doses.CONCLUSIONS: Higher statin doses and lower LDL cholesterol correlate with lower perioperative myocardial ischemia, perioperative troponin T release, and 30-day and late cardiac events in major vascular surgery.

AB - OBJECTIVES: This study sought to examine whether higher statin doses and lower low-density lipoprotein (LDL) cholesterol are associated with improved cardiac outcome in vascular surgery patients.BACKGROUND: Statins may have cardioprotective effects during major vascular surgery.METHODS: In a prospective study of 359 vascular surgery patients, statin dose and cholesterol levels were recorded preoperatively. Myocardial ischemia and heart rate variability were assessed by 72-h 12-lead electrocardiography starting 1 day before to 2 days after surgery. Troponin T was measured on postoperative day 1, 3, 7, and before discharge. Cardiac events included cardiac death or nonfatal Q-wave myocardial infarction at 30 days and follow-up (mean 2.3 years).RESULTS: Perioperative myocardial ischemia, troponin T release, 30-day events, and late cardiac events occurred in 29%, 23%, 4%, and 18%, respectively. In multivariate analysis, lower LDL cholesterol (per 10 mg/dl) correlated with lower myocardial ischemia (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80 to 0.95), troponin T release (OR 0.89, 95% CI 0.82 to 0.96), and 30-day (OR 0.89, 95% CI 0.78 to 1.00) and late cardiac events (hazard ratio 0.91, 95% CI 0.84 to 0.96). Higher statin doses (per 10% of maximum recommended dose) correlated with lower myocardial ischemia (OR 0.85, 95% CI 0.76 to 0.93), troponin T release (OR 0.84, 95% CI 0.76 to 0.93), and 30-day (OR 0.62, 95% CI 0.40 to 0.96) and late cardiac events (hazard ratio 0.76, 95% CI 0.65 to 0.89), even after adjusting for LDL cholesterol. Significantly higher perioperative heart rate variability was observed in patients with higher statin doses.CONCLUSIONS: Higher statin doses and lower LDL cholesterol correlate with lower perioperative myocardial ischemia, perioperative troponin T release, and 30-day and late cardiac events in major vascular surgery.

KW - Aged

KW - Biomarkers/metabolism

KW - Cholesterol, LDL/drug effects

KW - Dose-Response Relationship, Drug

KW - Female

KW - Heart Rate/drug effects

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage

KW - Male

KW - Multivariate Analysis

KW - Myocardial Ischemia/diagnosis

KW - Outcome Assessment, Health Care

KW - Prospective Studies

KW - Troponin T/drug effects

KW - Vascular Surgical Procedures

U2 - 10.1016/j.jacc.2007.06.046

DO - 10.1016/j.jacc.2007.06.046

M3 - Article

C2 - 17950146

SN - 0735-1097

VL - 50

SP - 1649

EP - 1956

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 17

ER -

Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery

Abstract

Keywords

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