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Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 2001;37:63–69. Association Between Short-Term Simvastatin Therapy Before Coronary Artery Bypass Grafting and Postoperative Myocardial Blood Flow as Assessed by Positron Emission Tomography M. Imran Dotani, MD, Anthony P. Morise, MD, Reyaz Haque, MD, Abnash C. Jain, MD, Naresh Gupta, MD, and C. Michael Gibson, MS, MD A previous retrospective study demonstrated im- proved outcomes associated with short-term (3 to 5 days) preoperative statin treatment in patients who underwent coronary artery bypass grafting (CABG). 1 In light of this observational data, we believed that a prospective study of preoperative statin therapy was warranted. We hypothesized that preoperative simva- statin therapy would be associated with improvements in myocardial perfusion on positron emission tomog- raphy (PET) scanning above and beyond what may be expected strictly from the placement of bypass con- duits. ••• Patients with known 3-vessel coronary artery dis- ease diagnosed by coronary angiography, scheduled for elective CABG surgery, and who were willing to undergo pre- and postoperative PET scanning were considered for the study. Exclusion criteria included unstable angina or myocardial infraction with an ur- gent or emergency requirement for surgery, secondary hypercholesterolemia due to conditions such as hypo- or hyperthyroidism, malignancy within 5 years except basal cell carcinoma, active liver disease or hepatic dysfunction, current use of cyclosporin, oral contra- ceptives, or other p-450 enzyme inhibitors, current use of cholesterol-lowering medications, and drug and/or alcohol abuse. The study was approved by the insti- tutional review board at West Virginia University Hospital. Between April 2001 and February 2002, 10 pa- tients were randomized in a double-blind fashion to either placebo or simvastatin 40 mg/day. All patients received simvastatin or placebo therapy for 14  2 days, with therapy 4  1 days before CABG and 10  1 days after CABG. All patients were discharged From the Beth Israel Deaconess Medical Center, Boston, Massachu- setts; and West Virginia University Hospitals, Morgantown, West Virginia. This report was supported in part by a research grant from Merck, Inc., Whitehouse Station, New Jersey. Dr. Dotani’s address is: One Deaconess Road, Baker 4, Section of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215. E-mail: mdotani@caregroup.harvard.edu. Manuscript received October 14, 2002; revised manuscript received and accepted January 27, 2003. TABLE 1 Baseline Characteristics Variable Placebo Group Simvastatin Group p Value Age (yrs) 67  5 57  7 0.3 Left ventricular ejection fraction (%) 45  16.8 40  17 0.69 Smoker 50% 75% 0.26 Diabetes mellitus 75% 0% 0.14 Systemic hypertension 100% 100% 1.0  blockers 100% 75% 1.0 Angiotensin-converting enzyme inhibitors 50% 50% 1.0 Aspirin 100% 75% 1.0 No. of bypasses 2.5  0.4 3.5  0.4 0.14 Creatinine (mg/dl) 1.25  0.27 1.17  0.27 0.85 Nonbypassed regions 1.3  10 4  7* 0.8 Bypassed regions 10  13 49  6* 0.001 *p = 0.012. 1107 ©2003 by Excerpta Medica, Inc. All rights reserved. 0002-9149/03/$–see front matter The American Journal of Cardiology Vol. 91 May 1, 2003 doi:10.1016/S0002-9149(03)00158-9