Trial reportEuropean heart journal2016

Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study.

Otavio Berwanger, Yannick Le Manach, Erica Aranha Suzumura, Bruce Biccard, Sadeesh K Srinathan, Wojciech Szczeklik, Jose A Espirito Santo, Eliana Santucci, Alexandre B Cavalcanti, R Andrew Archbold and 2 more

2 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in European heart journal, 2016. The graph read 4 numbers from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. It also reports 4 associations that do not count as treatment evidence, such as RR 0.86 (0.73 to 0.98) for MINS. It is linked to 2 registered trials, which are not on this map. Cited by 39 papers, 5 of them syntheses that pooled it.

4numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 5 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

MINSpre-operative statin therapy vs no pre-operative statin therapy (controls)an association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
RR 0.860.73 to 0.98P = 0.02
Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02).
Composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 dayspre-operative statin therapy vs no pre-operative statin therapy (controls)an association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
RR 0.830.73 to 0.95P = 0.007
The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73-0.95; P = 0.007].
Cardiovascular mortalitypre-operative statin therapy vs no pre-operative statin therapy (controls)an association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
RR 0.420.23 to 0.76P = 0.004
Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02).
All-cause mortalitypre-operative statin therapy vs no pre-operative statin therapy (controls)an association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
RR 0.580.40 to 0.83P = 0.003
Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×cardiovascular events

No readable resultOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
HR 0.710.56 to 0.90
NCT023442907,769 enrolled · 2015
HR 0.640.48 to 0.84
HR 1.781.00 to 3.17
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×all-cause mortality

No readable resultOpen on the map →What to test next →

14 readable studies in this cell: 3 favour the treatment, 9 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00512109 completednot on this map

Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study

TypeobservationalSponsorMcMaster UniversityRan2007 to 2014Enrolled40,060ConditionsVascular Death, Myocardial Infarction, Cardiac Arrest, Stroke
NCT04053894 unknown statusnot on this mapstarted 2019, after this paper: background citation

Association of PeriOPerative Aspirin-ResisTance and CardioVascular Outcome

TypeobservationalSponsorUniversity Hospital HeidelbergRan2019 to 2020Enrolled220ConditionsVascular Surgery
5 · Its place in the literature

Who cites it

39 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Arquivos brasileiros de cardiologia · 2017
    Guideline
  2. Guideline
  3. Pooled it
  4. Guideline
  5. Pooled it
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Review
  14. Observational
  15. Article
  16. Perioperative Myocardial Injury.Turkish journal of anaesthesiology and reanimation · 2023
    Article
  17. Observational
  18. Article
  19. Review
  20. Article
6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

12 authors.

Otavio BerwangerResearch Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil oberwanger@hcor.com.br.
Yannick Le ManachPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Erica Aranha SuzumuraResearch Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Bruce BiccardPerioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
Sadeesh K SrinathanDepartment of Surgery, University of Manitoba, Winnipeg, MB, Canada.
Wojciech SzczeklikJagiellonian University Medical College, Krakow, Poland.
Jose A Espirito SantoResearch Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Eliana SantucciResearch Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
Alexandre B CavalcantiResearch Institute - Heart Hospital (Hospital do Coração - HCor), Rua Abílio Soares 250, 12 Andar, São Paulo, SP 04005-000, Brazil.
R Andrew ArchboldBarts Heart Centre, Barts Health NHS Trust, London, UK.
P J DevereauxPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
VISION Investigators

Funding

Canadian Institutes of Health Research
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

aimsThe aim of this study was to assess the effects of pre-operative statin therapy on cardiovascular events in the first 30-days after non-cardiac surgery. METHODS AND

resultsWe conducted an international, prospective, cohort study of patients who were ≥45 years having in-patient non-cardiac surgery. We estimated the probability of receiving statins pre-operatively using a multivariable logistic model and conducted a propensity score analysis to correct for confounding. A total of 15 478 patients were recruited at 12 centres in eight countries from August 2007 to January 2011. The matched population consisted of 2845 patients (18.4%) treated with a statin and 4492 (29.0%) controls. The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73-0.95; P = 0.007]. Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02). There were no statistically significant differences in the risk of myocardial infarction or stroke.

conclusionAmong patients undergoing non-cardiac surgery, pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days. These results require confirmation in a large randomized trial. CLINICAL

trial registrationClinical Trials.gov NCT00512109.

Indexed as

AdultAgedCardiovascular DiseasesCause of DeathFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPostoperative ComplicationsPreoperative CareProspective StudiesRisk FactorsTreatment OutcomeHydroxymethylglutaryl-CoA Reductase InhibitorsCohort studiesMultivariate analysisPerioperative periodPropensity scoreStatinSurgical procedures

Identifiers

PMID26330424
PMCPMC4703907

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.