Statin loading before coronary artery bypass grafting: a randomized trial
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Statin loading before coronary artery bypass grafting: a randomized trial. / 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; StaRT-CABG Investigators.
In: EUR HEART J, Vol. 44, No. 25, 01.07.2023, p. 2322-2331.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Statin loading before coronary artery bypass grafting: a randomized trial
AU - Liakopoulos, Oliver J
AU - Kuhn, Elmar W
AU - Hellmich, Martin
AU - Schlömicher, Markus
AU - Strauch, Justus
AU - Reents, Wilko
AU - Diegeler, Anno
AU - Thielmann, Matthias
AU - Wendt, Daniel
AU - Börgermann, Jochen
AU - Gummert, Jan F
AU - Stoppe, Christian
AU - Goetzenich, Andreas
AU - Martens, Sven
AU - Reichenspurner, Hermann
AU - Wippermann, Jens
AU - Reuter, Hannes
AU - Choi, Yeong-Hoon
AU - Wahlers, Thorsten
AU - StaRT-CABG Investigators
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - 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.
AB - 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.
KW - Adult
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
KW - Treatment Outcome
KW - Coronary Artery Bypass/methods
KW - Myocardial Infarction/prevention & control
KW - Percutaneous Coronary Intervention/methods
KW - Death
KW - Coronary Artery Disease
U2 - 10.1093/eurheartj/ehad238
DO - 10.1093/eurheartj/ehad238
M3 - SCORING: Journal article
C2 - 37086268
VL - 44
SP - 2322
EP - 2331
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 25
ER -
