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Statin therapy is associated with improved outcomes in vascular surgery patients with renal impairment
Gijs M J M Welten1, Michel Chonchol, Sanne E Hoeks
1Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Baseline kidney function impacts vascular surgery outcomes. Statin use improves survival for patients with kidney disease, reducing both short- and long-term mortality.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Clinical Outcomes Research
Background:
- Limited understanding of the interplay between baseline kidney function, statin therapy, and patient outcomes following vascular surgery.
- Investigating these associations in patients with and without chronic kidney disease is crucial for optimizing perioperative care.
Purpose of the Study:
- To evaluate the impact of baseline kidney function on short- and long-term outcomes after major vascular surgery.
- To determine the effect of statin therapy on mortality in this patient population, stratified by kidney function.
Main Methods:
- Analysis of 2126 patients undergoing elective major vascular surgery, categorized by baseline creatinine clearance (CrCl < 60 mL/min vs. CrCl >= 60 mL/min).
- Outcome measures included 30-day and long-term all-cause, cardiac, and cerebrocardiovascular mortality.
- Multivariate Cox regression and propensity score analysis were employed to adjust for confounders.
Main Results:
- Patients with CrCl < 60 mL/min exhibited significantly higher 30-day and long-term mortality rates across all outcome measures compared to those with CrCl >= 60 mL/min.
- Statin therapy was independently associated with improved 30-day and long-term all-cause mortality.
- Beneficial effects of statins on cardiac and cerebrocardiovascular mortality reached statistical significance only in patients with CrCl < 60 mL/min.
Conclusions:
- Baseline kidney function is an independent predictor of both short- and long-term outcomes following major vascular surgery.
- Perioperative statin use demonstrates a significant mortality benefit in patients with kidney disease, encompassing all-cause, cardiac, and cerebrocardiovascular events.
Background:
Little is known about the association between baseline kidney function, statin therapy, and outcome after vascular surgery in patients with and without chronic kidney disease.
Methods:
A total of 2126 patients underwent elective major vascular surgery and were divided into 2 categories based on baseline creatinine clearance (CrCl), calculated using the Cockcroft-Gault equation: CrCl > or = 60 mL/min (n = 1358, reference) and CrCl < 60 mL/min (n = 768). Outcome measures were 30-day and long-term all-cause, cardiac, and cerebrocardiovascular mortality. Mean follow-up was 6.0 +/- 3.7 years. Multivariate Cox regression analysis, including potential confounders and propensity score for statin use, was applied. Data are presented as hazard ratios (HRs) with 95% CI.
Results:
Thirty-day all-cause, cardiac, and cerebrocardiovascular mortality rates were 3.8% versus 10.2%, 1.3% versus 4.2%, and 2.7% versus 7.8%, respectively, according to the 2 categories of kidney function. In addition, long-term all-cause, cardiac, and cerebrocardiovascular mortality rates were 46.6% versus 72.5%, 14.6% versus 26.4%, and 23.0% versus 40.6%, respectively. Statin therapy was associated with an overall significant improved 30-day and long-term all-cause mortality, independent of other important confounders. However, in patients with a CrCl > or = 60 mL/min, the long-term cardiac and cerebrocardiovascular beneficial effects did not reach statistical significance (HR 0.93, 95% CI 0.61-1.41 and HR 0.89, 95% CI 0.63-1.24, respectively) when compared with patients with a CrCl of < 60 mL/min (HR 0.63, 95% CI 0.41-0.96 and HR 0.67, 95% CI 0.48-0.94, respectively).
Conclusions:
The level of kidney function is an independent predictor of short- and long-term outcome after major noncardiac surgery. In addition, perioperative statin use in patients with kidney disease is associated with a reduction in the short- and long-term all-cause, cardiac, and cerebrocardiovascular mortality.
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