Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year
Bjoern D Suckow1, Larry W Kraiss1, Andres Schanzer2
1Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Insights
Statin therapy improves long-term survival after infrainguinal bypass in patients with critical limb ischemia (CLI). However, statins did not impact amputation or graft occlusion rates within one year for these patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- Statin therapy is known to reduce short-term complications post-infrainguinal bypass.
- The long-term impact of statins on survival after this procedure remains uncertain.
Purpose of the Study:
- To investigate the association between statin use and long-term mortality.
- To examine the effect of statins on graft occlusion and amputation rates following infrainguinal bypass.
Main Methods:
- Analysis of 2067 patients undergoing infrainguinal bypass from the Vascular Study Group of New England registry (2003-2011).
- Comparison of outcomes between patients on statins (n=1537) and those not on statins (n=530).
- Evaluation of crude, adjusted, and propensity-matched rates for 5-year survival, 1-year amputation, graft occlusion, and perioperative myocardial infarction.
Main Results:
- Patients on statins had higher comorbidity burdens but demonstrated improved 5-year survival in all analyses (crude, adjusted, propensity-matched).
- A significant survival advantage for statin users was observed in patients with critical limb ischemia (CLI), but not in those with claudication.
- Statin use was not associated with 1-year amputation or graft occlusion rates in CLI patients.
Conclusions:
- Statin therapy is linked to a 5-year survival benefit for patients with critical limb ischemia undergoing infrainguinal bypass.
- Statin use did not influence 1-year limb-related outcomes (amputation, graft occlusion) in this observational study.
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.
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.
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).
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.
