Effect of Statin Intensity on Cardiovascular Outcomes and Survival Following Coronary Artery Bypass Grafting

Background

High-intensity statins are recommended for patients with chronic coronary artery disease, with reports suggesting improved clinical outcomes. However, recent findings in coronary artery bypass graft (CABG) patients question whether a treat-to-target low density lipoprotein (LDL) approach is non-inferior to high-intensity statin therapy.

Methods

This single-center observational study analyzed all CABG only (n = 1854) procedures performed between 2013 and 2015. Patients were divided into three groups based on statin prescription: high-intensity statin therapy (atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg), low/moderate-intensity statin therapy, and a no-statin group. The primary outcome measured was major adverse cardiovascular events (MACE), a composite of post-CABG acute coronary syndrome, cerebrovascular accident and cardiovascular mortality.

Results

No-Statin group had significantly higher incidence of MACE compared to statin group (14.2% vs 8.9%; odds ratio (OR) 1.60, 95% confidence interval (CI) 1.055–2.427, p = 0.029). Low/moderate-intensity therapy (n = 1301) was associated with a numerically higher overall rate of MACE compared to high-intensity therapy (n = 397) but was not statistically significant (9.6% vs 6.6%; OR 1.45, CI 0.961–2.172, p = 0.073). Beyond 2 years post-CABG, low/moderate intensity statin use was associated with a significant higher incidence of MACE (9.1% vs 5.3%; OR 1.72, 95% CI 0.993–2.978, p = 0.047) compared to high intensity statins.

Patients who received high-intensity statin therapy had the lowest LDL levels (82.21 ± 41.85 mg/dL), compared to those on low/moderate-intensity statins (90.84 ± 45.89 mg/dL) and no-statin group (104.83 ± 38.93 mg/dL, p < 0.001).

Conclusion

High-intensity statin therapy following CABG is associated with improved long-term clinical outcomes compared to low- or moderate-intensity statin regimens.