PMID- 26409843 OWN - NLM STAT- MEDLINE DCOM- 20160502 LR - 20220330 IS - 1097-6809 (Electronic) IS - 0741-5214 (Print) IS - 0741-5214 (Linking) VI - 63 IP - 1 DP - 2016 Jan TI - Preoperative antiplatelet and statin treatment was not associated with reduced myocardial infarction after high-risk vascular operations in the Vascular Quality Initiative. PG - 182-9.e2 LID - S0741-5214(15)01806-6 [pii] LID - 10.1016/j.jvs.2015.08.058 [doi] AB - OBJECTIVE: Medical management with antiplatelet (AP) and statin therapy is recommended for nearly all patients undergoing vascular surgery to reduce cardiovascular events. We assessed the association between preoperative use of AP and statin medications and postoperative in-hospital myocardial infarction (MI) in patients undergoing high-risk open surgery. METHODS: We studied patients who underwent elective suprainguinal (n = 3039) and infrainguinal (n = 8323) bypass and open infrarenal abdominal aortic aneurysm repair (n = 3007) in the Vascular Quality Initiative (VQI, 2005-2014). We assessed the association between AP or statin use and in-hospital postoperative MI and MI/death. Multivariable logistic analyses were performed to identify the patient, procedure, and preoperative medication factors associated with postoperative MI and MI/death across procedures and patient cardiac risk strata. Secondary end points included bleeding, transfusion, and thrombotic complications. RESULTS: Most patients were taking both AP and statin preoperatively (56% both agents vs 19% AP only, 13% statin only, and 12% neither agent). Use of both agents was more common for patients in the highest cardiac risk stratum (low, 54%; intermediate, 59%; high, 61%; P < .01). Increased cardiac risk was associated with higher MI rates (1.8% vs 3.8% vs 6.5% for low, intermediate, and high risk; P < .01). By univariate analysis, MI rate was paradoxically higher for patients taking both agents (3.7%, vs statin only 2.8%, AP only 2.6%, or neither AP nor statin 2.4%; P = .003). After multivariable adjustment, rates of MI in patients taking preoperative AP only (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.7-1.2) and statin only (OR, 0.8; 95% CI, 0.6-1.2) were not different from those in patients taking either or neither medication (neither agent compared with taking both agents: OR, 1.0; 95% CI, 0.7-1.4; P > .05 for all). Similarly, rates of MI/death were not associated with medication status after multivariable adjustment. Estimated blood loss >1 liter (OR, 2.4; 95% CI, 1.6-3.7; P < .01) and transfusions of 1 or 2 units (OR, 2.5; 95% CI, 2.0-3.3; P < .01) and >/=3 units (OR, 4.0; 95% CI, 3.1-5.3; P < .01) were highly associated with MI, with similar findings related to composite MI/death in multivariable analysis. Rates of blood loss were slightly higher with AP use for all procedures; however, increased transfusions occurred only for infrainguinal bypass with AP use. Rates of reoperation for bleeding, graft thrombosis, or graft revision did not differ by preoperative AP use. CONCLUSIONS: Preoperative AP and statin medications as used in VQI were not associated with the rate of in-hospital MI/death after major open vascular operations. Rather, predicted cardiac risk and operative blood loss were significantly associated with in-hospital MI or MI/death. AP and statin medications appear to be more useful in reducing late mortality than early postoperative MI/death in VQI. However, they were not harmful, so their long-term benefit argues for continued use. CI - Copyright (c) 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - De Martino, Randall R AU - De Martino RR AD - Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: demartino.randall@mayo.edu. FAU - Beck, Adam W AU - Beck AW AD - Division of Vascular Surgery & Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla. FAU - Hoel, Andrew W AU - Hoel AW AD - Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill. FAU - Hallett, John W AU - Hallett JW AD - Roper Vascular Care, Roper St. Francis Heart & Vascular Center, Charleston, SC. FAU - Arya, Shipra AU - Arya S AD - Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, Ga. FAU - Upchurch, Gilbert R Jr AU - Upchurch GR Jr AD - Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va. FAU - Cronenwett, Jack L AU - Cronenwett JL AD - Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. FAU - Goodney, Philip P AU - Goodney PP AD - Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. CN - Vascular Quality Initiative LA - eng GR - K08 HL105676/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20150926 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Platelet Aggregation Inhibitors) SB - IM MH - Aged MH - Aortic Aneurysm, Abdominal/mortality/*surgery MH - Blood Vessel Prosthesis Implantation/*adverse effects/mortality MH - Chi-Square Distribution MH - Elective Surgical Procedures MH - Female MH - Hospital Mortality MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Myocardial Infarction/etiology/mortality/*prevention & control MH - Odds Ratio MH - Peripheral Arterial Disease/mortality/*surgery MH - Platelet Aggregation Inhibitors/*therapeutic use MH - Postoperative Hemorrhage/mortality/prevention & control MH - Protective Factors MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - United States PMC - PMC5292256 MID - NIHMS845638 COIS- Author conflict of interest: none. EDAT- 2015/09/28 06:00 MHDA- 2016/05/03 06:00 PMCR- 2017/02/05 CRDT- 2015/09/28 06:00 PHST- 2015/03/30 00:00 [received] PHST- 2015/08/05 00:00 [accepted] PHST- 2015/09/28 06:00 [entrez] PHST- 2015/09/28 06:00 [pubmed] PHST- 2016/05/03 06:00 [medline] PHST- 2017/02/05 00:00 [pmc-release] AID - S0741-5214(15)01806-6 [pii] AID - 10.1016/j.jvs.2015.08.058 [doi] PST - ppublish SO - J Vasc Surg. 2016 Jan;63(1):182-9.e2. doi: 10.1016/j.jvs.2015.08.058. Epub 2015 Sep 26.