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- Title
Statin loading before coronary artery bypass grafting: a randomized trial.
- Authors
Liakopoulos, Oliver J; Kuhn, Elmar W; Hellmich, Martin; Schlömicher, Markus; Strauch, Justus; Reents, Wilko; Diegeler, Anno; Thielmann, Matthias; Wendt, Daniel; Börgermann, Jochen; Gummert, Jan F; Stoppe, Christian; Goetzenich, Andreas; Martens, Sven; Reichenspurner, Hermann; Wippermann, Jens; Reuter, Hannes; Choi, Yeong-Hoon; Wahlers, Thorsten; Investigators, for the StaRT-CABG
- Abstract
Aims Evidence suggests that a high-dose statin loading before a percutaneous coronary revascularization improves outcomes in patients receiving long-term statins. This study aimed to analyse the effects of such an additional statin therapy before surgical revascularization. Methods and results This investigator-initiated, randomized, double-blind, and placebo-controlled trial was conducted from November 2012 to April 2019 at 14 centres in Germany. Adult patients (n = 2635) with a long-term statin treatment (≥30 days) who were scheduled for isolated coronary artery bypass grafting (CABG) were randomly assigned to receive a statin-loading therapy or placebo at 12 and 2 h prior to surgery using a web-based system. The primary outcome of major adverse cardiac and cerebrovascular events (MACCE) was a composite consisting of all-cause mortality, myocardial infarction (MI), and a cerebrovascular event occuring within 30 days after surgery. Key secondary endpoints included a composite of cardiac death and MI, myocardial injury, and death within 12 months. Non-statistically relevant differences were found in the modified intention-to-treat analysis (2406 patients; 1203 per group) between the statin (13.9%) and placebo groups (14.9%) for the primary outcome [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.74–1.18; P = 0.562] or any of its individual components. Secondary endpoints including cardiac death and MI (12.1% vs. 13.5%; OR 0.88, 95% CI 0.69–1.12; P = 0.300), the area under the troponin T-release curve (median 0.398 vs. 0.394 ng/ml, P = 0.333), and death at 12 months (3.1% vs. 2.9%; P = 0.825) were comparable between treatment arms. Conclusion Additional statin loading before CABG failed to reduce the rate of MACCE occuring within 30 days of surgery.
- Subjects
GERMANY; CORONARY artery bypass; REVASCULARIZATION (Surgery); STATINS (Cardiovascular agents); MYOCARDIAL injury; MYOCARDIAL infarction; DRUG-eluting stents
- Publication
European Heart Journal, 2023, Vol 44, Issue 25, p2322
- ISSN
0195-668X
- Publication type
Article
- DOI
10.1093/eurheartj/ehad238