High dose statin prophylaxis in cardiopulmonary bypass related surgery: clinical utility
| Autor: | Lars Nölke, David Healy, Yie Roei Chee, Jehan Zeb Chughtai, R. William G. Watson, J McCarthy |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Statin medicine.drug_class Atorvastatin lcsh:Surgery Urine 030204 cardiovascular system & hematology law.invention lcsh:RD78.3-87.3 03 medical and health sciences 0302 clinical medicine Lipocalin-2 Randomized controlled trial law medicine Cardiopulmonary bypass Humans Prospective Studies Cardiac Surgical Procedures Aged Dose-Response Relationship Drug biology business.industry Interleukin-8 End-organ injury General Medicine lcsh:RD1-811 Middle Aged Troponin Systemic Inflammatory Response Syndrome Cardiac surgery Surgery 030228 respiratory system Cardiothoracic surgery lcsh:Anesthesiology Anesthesia biology.protein Female Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine business Biomarkers Research Article medicine.drug |
| Zdroj: | Journal of Cardiothoracic Surgery, Vol 12, Iss 1, Pp 1-10 (2017) Journal of Cardiothoracic Surgery |
| ISSN: | 1749-8090 |
| DOI: | 10.1186/s13019-017-0582-8 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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