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Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2015 Jan; Vol. 61 (1), pp. 126-33. Date of Electronic Publication: 2014 Jul 16. - Publication Year :
- 2015
-
Abstract
- Objective: Although statin therapy has been linked to fewer short-term complications after infrainguinal bypass, its effect on long-term survival remains unclear. We therefore examined associations between statin use and long-term mortality, graft occlusion, and amputation after infrainguinal bypass.<br />Methods: We used the Vascular Study Group of New England registry to study 2067 patients (71% male; mean age, 67 ± 11 years; 67% with critical limb ischemia [CLI]) who underwent infrainguinal bypass from 2003 to 2011. Of these, 1537 (74%) were on statins perioperatively and at 1-year follow-up, and 530 received no statin. We examined crude, adjusted, and propensity-matched rates of 5-year surviva1, 1-year amputation, graft occlusion, and perioperative myocardial infarction.<br />Results: Patients taking statins at the time of surgery and at the 1-year follow-up were more likely to have coronary disease (38% vs 22%; P < .001), diabetes (51% vs 36%; P < .001), hypertension (89% vs 77%; P < .001), and prior revascularization procedures (50% vs 38%; P < .001). Despite higher comorbidity burdens, long-term survival was better for patients taking statins in crude (risk ratio [RR], 0.7; P < .001), adjusted (hazard ratio, 0.7; P = .001), and propensity-matched analyses (hazard ratio, 0.7; P = .03). In subgroup analysis, a survival advantage was evident in patients on statins with CLI (5-year survival rate, 63% vs 54%; log-rank, P = .01) but not claudication (5-year survival rate, 84% vs 80%; log-rank, P = .59). Statin therapy was not associated with 1-year rates of major amputation (12% vs 11%; P = .84) or graft occlusion (20% vs 18%; P = .58) in CLI patients. Perioperative myocardial infarction occurred more frequently in patients on a statin in crude analysis (RR, 2.2; P = .01) but not in the matched cohort (RR, 1.9; P = .17).<br />Conclusions: Statin therapy is associated with a 5-year survival benefit after infrainguinal bypass in patients with CLI. However, 1-year limb-related outcomes were not influenced by statin use in our large observational cohort of patients undergoing revascularization in New England.<br /> (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Amputation, Surgical
Chi-Square Distribution
Comorbidity
Critical Illness
Female
Graft Occlusion, Vascular etiology
Graft Occlusion, Vascular physiopathology
Humans
Ischemia diagnosis
Ischemia mortality
Ischemia physiopathology
Kaplan-Meier Estimate
Limb Salvage
Logistic Models
Male
Middle Aged
Myocardial Infarction etiology
New England
Odds Ratio
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease mortality
Peripheral Arterial Disease physiopathology
Propensity Score
Proportional Hazards Models
Registries
Reoperation
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation mortality
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Ischemia therapy
Lower Extremity blood supply
Peripheral Arterial Disease therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 61
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25037607
- Full Text :
- https://doi.org/10.1016/j.jvs.2014.05.093