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The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular
R Parker Ward1, Nicholas J Leeper, James N Kirkpatrick
1Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC5084, Chicago, IL 60637, USA. pward@medicine.bsd.uchicago.edu
Insights
Preoperative statin therapy in vascular surgery patients significantly reduces cardiac and vascular complications, shortens hospital stays, and improves long-term survival. This finding highlights the benefits of statins for patients undergoing infrainguinal bypass surgery.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Pharmacology
Background:
- Patients undergoing vascular surgery face elevated risks of perioperative cardiovascular complications.
- Infrainguinal vascular bypass surgery presents specific challenges for patient outcomes.
Purpose of the Study:
- To evaluate the impact of preoperative statin therapy on perioperative cardiac and vascular outcomes.
- To assess the effect of statin use on long-term survival in patients undergoing infrainguinal vascular bypass surgery.
Main Methods:
- Retrospective review of 446 infrainguinal vascular bypass surgeries (1995-2001).
- Data collected on statin/beta-blocker use, complications, and length of stay (LOS).
- Long-term survival assessed via Social Security Death Index (SSDI).
Main Results:
- Statin therapy correlated with fewer combined cardiovascular complications (6.9% vs. 20.1%) and shorter LOS (6.4 vs. 9.7 days).
- Multivariate analysis confirmed statins independently reduced combined CV complications (OR 0.36) and LOS (OR 1.49).
- Statin use was independently linked to improved long-term survival (OR 0.52) over a 5.5-year follow-up.
Conclusions:
- Preoperative statin therapy is associated with reduced perioperative cardiac and vascular complications.
- Statin use leads to a shorter hospital length of stay.
- Preoperative statin administration improves long-term survival in patients undergoing infrainguinal vascular bypass surgery.
Background:
Patients undergoing vascular surgery are at increased risk for perioperative cardiovascular (CV) complications. Our goal was to determine the effect of preoperative statin therapy on perioperative cardiac and vascular outcomes, and long-term survival in patients undergoing infrainguinal vascular bypass surgery.
Methods:
We retrospectively reviewed consecutive infrainguinal vascular bypass surgeries on 446 patients performed between 1995-2001 at the University of Chicago Medical Center. Information was collected on preoperative statin and beta-blocker use, baseline characteristics, perioperative cardiac and major vascular complications, and length of stay (LOS). Long-term survival was assessed using the Social Security Death Index (SSDI).
Results:
Thirty day perioperative complications included all-cause mortality (2.5%), CV mortality (1.8%), myocardial infarction (MI) (4.7%), stroke (1.1%), and major peripheral vascular complications (12.8%), and the composite of cardiac and vascular complications [combined CV complications] (17.9%). Statin therapy was associated with fewer combined CV complications (6.9% vs 20.1%, p=0.008), and a shorter LOS (6.4 vs 9.7 days, p=0.007). On multivariate logistic regression analysis, adjusting for significant baseline characteristics including beta-blocker use, statin therapy was independently associated fewer combined CV complications (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.14-0.93, p=0.035) and a shorter LOS (OR 1.49, 95% CI 1.14-1.95, p=0.003). In a mean follow up period of 5.5 years, 215 deaths (48%) occurred. Statin therapy was independently associated with improved long-term survival (OR 0.52, 95% CI 0.32-0.84, p<0.004), after adjusting for significant baseline characteristics.
Conclusion:
Preoperative statin therapy is associated with fewer combined perioperative cardiac and major vascular complications, a shorter length of stay, and improved long-term survival in patients undergoing infrainguinal vascular bypass surgery.
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