STATINS AND PERIOPERATIVE MYOCARDIAL INFARCTION
Keywords:
statins, myocardial infarction, perioperative periodAbstract
The aim of the research — to resolve the question about the necessity of perioperative application of statins and their roles for forming cardiovascular risks. Material and methods. In our research we used the following statins — atorvastatin and flavostatin. In the first prospective, randomized test there were examined 100 patients. The 1st group was indicated atorvastatin 20 mg before the vascular operation, the 2nd — placebo once a day during 45 days, regardless of concentration of cholesterol in blood serum. Vascular procedure was executed 31 days after randomization of patients. Control was conducted within 6 months after the operation. In another research flavostatin was used in 497 patients of vascular profile by 80 mg 1 time every day. In the group of comparison placebo was applied. Therapy began 37 days before the operation. Retrospective research was executed in 981 patients, after implementation of vascular operation, on a background the protracted intake of statins, with the purpose to registrate complications: cases of acute tubular necrosis, increase of creatine kinase level, signs of myopathy. Results. In case with atorvastatin, control was conducted for 6 months after the operation. During this term atorvastatin considerably decreased the rate of cardiovascular events (8% against 26%). A meta-analysis of 223,010 patients from 12 retrospective and 3 prospective tests with statins showed the decline of lethality by 44% in general surgery and by 59% — in vascular surgery. With use of flavostatin: myocardial ischemia in this research was observed in 10.8% (group of flavostatin) against 19% (group of placebo). The level of cardiac death or acute miocardial infarction in these two groups made 4.8 and 10.2% correspondingly. Distinctions in groups in all enumerated researches are reliable. The retrospective research of 981 patients didnot show the events of acute tubular necrosis, increase of creatine kinase level, myopathy signs after the vascular operation. Conclusion. So, the occurrence of acute myocardial infarction in the early postoperative period is often preceded by episodes of recurrent myocardial ischemia. Besides of certain strategies of risk reduction, there is an ability to monitor and optimize cardiovascular risk factors involving statin therapy. Various foreign communities made recommendations for the use of statins for the risk patients. The basis for these recommendations is the widespread use of drugs in groups of high risk for cardiovascular complications.
References
Aronov D. M. Pleiotropic effects of statins / D. M. Aronov // Breast Cancer. – 2001. – Vol. 9. – P. 13–14.
Acute coronary syndrome. Diagnosis and treatment / L. A. Boqueria, U. I. Buziashvili, V. S. Workers [et al.]. – M. : Publishing NTSSSH. ANBakulev Medical Sciences, 2004. – 286 p.
Kosarev V. V. Pharmacotherapy of coronary heart disease: the place of statins / V. V. Kosarev, S. A. Babanov // Russian Medical Journal. – 2010. – Vol. 22. – P. 1302.
Oleinikova G. L. Coronary heart disease: the place of statins / G. L. Oleinikova // Russian melitsinsky magazine. – 2010. – N 3. – P. 153.
Yakusevich V. V. Early use of statins in acute coronary syndrome: a time for discussion or implementation of clinical practice guidelines? / V. V. Yakusevich // Russian Medical Journal. – 2011. – N 26. – P. 1662.
Arora V. Preoperative assessment of cardiac risk and perioperative cardiac management in noncardiac surgery / V. Arora, V. Velanovich, W. Alarcon // Int J Surg. – 2011. – Vol. 9 (1). – P. 23–28.
Acute myocardial infarction / E. Boersma, N. Mercado, D. Poldermans [et al.] // Lancet. – 2003. – Vol. 361. – P. 847–858.
Casscells W. Vulnerable atherosclerotic plaque. A multifocal disease / W. Casscells, M. Naghavi, J. T. Willerson // Circulation. – 2003. – Vol. 107. – P. 2072–2075.
Corti R. Pathogenic concepts of acute coronary syndromes / R. Corti, V. Fuster, J. J. Badimon // J. Am. Coll. Cardiol. – 2003. – Vol. 41. – P. 75–145.
Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial / A. E. Durazzo, F. S. Machado, D. T. Ikeoka [et al.] // J. Vasc. Surg. – 2004. – Vol. 39. – P. 967–975.
Forrester J. S. Role of plaque rupture in acute coronary syndromes / J. S. Forrester // Am. J. Cardiol. – 2000. – Vol. 86 (Suppl. 8B). – P. J15–23.
Fuster V. Acute coronary syndromes: biology / V. Fuster, Z. A. Fayad, J. J. Badimon //Lancet. – 1999. – Vol. 353 (Suppl. 2). – P. S115–119.
European guidelines on cardiovascular disease prevention in clinical practice: executive summary / I. Graham, D. Atar, K. Borch-Johnsen [et al.] // Eur. Heart J. – 2007. – Vol. 28. – P. 2375–2414.
Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA) // Eur Heart J. – 2009. – Vol. 30 (22). – P. 2769–2812.
Improved postoperative outcomes associated with preoperative statin therapy / K. Hindler, A. D. Shaw, J. Samuels [et al.] // Anesthesiology. – 2006. – Vol. 105. – P. 1260–1272; quiz 1289–1290.
Kereiakes D. J. The emperor’s clothes. In search of the vulnerable plaque / D. J. Kereiakes // Circulation. – 2003. – Vol. 107. – P. 2076–2077.
Maseri A. Is there a vulnerable plaque? / A. Maseri, V. Fuster // Circulation. – 2003. – Vol. 107. – P. 2068–2071.
Priebe H. J. Peri-operative myocardial infarction — aetiology and prevention / H. J. Priebe // Br. J. Anaesth. – 2005. – Vol. 95. – P. 3–19.
Rosenson R. S. Antiatherothrombotic properties of statins: implications for cardiovascular event reduction / R. S. Rosenson, C. C. Tangney // JAMA. – 1998. – Vol. 279. – P. 1643–1650.
Fluvastatin XL use is associated with improved cardiac outcome after major vascular surgery. Results from a randomized placebo controlled trial: DECREASE III / O. Schouten, E. Boersma, S. Hoeks [et al.] // Eur. Heart J. – 2008. – Vol. 29 (abstract supplement) (Hotline session ESC).
Effect of statin withdrawal on frequency of cardiac events after vascular surgery / O. Schouten, S. E. Hoeks, G. M. Welten [et al.] // Am. J. Cardiol. – 2007. – Vol. 100. – P. 316–320.
Safety of perioperative statin use in high-risk patients undergoing major vascular surgery / O. Schouten, M. D. Kertai, J. J. Bax [et al.] // Am. J. Cardiol. – 2005. – Vol. 95. – P. 658–660.
Williams T. M. Statins for surgical patients / T. M. Williams, A. H. Harken // Ann. Surg. – 2008. – Vol. 247. – P. 30–37.
