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Published on: September 22, 2020
Influence of Preprocedural Statin Usage on Primary Patency and Amputation in Patients Undergoing Lower Limb
Stela Karine Braun1, Daiane Wagner Jorge2, Vinicius Freitas Pedron3
1Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil; Surgery Department, Universidade Franciscana, Santa Maria, Rio Grande do Sul, Brazil.
Insights
Preprocedural statin use did not improve outcomes for patients undergoing peripheral angioplasty for critical limb ischemia or claudication. This study found no significant difference in patency or amputation rates between statin and non-statin groups.
Area of Science:
- Vascular Surgery
- Cardiology
- Pharmacology
Background:
- Peripheral arterial disease (PAD) can lead to critical limb ischemia (CLI), necessitating revascularization due to high amputation rates.
- Endovascular approaches for PAD have limitations in long-term patency, often due to restenosis from neointimal hyperplasia.
- Statins are known to benefit patients undergoing percutaneous interventions, but their impact on outcomes after endovascular treatment for PAD is less studied.
Purpose of the Study:
- To assess the effect of preprocedural statin use on outcomes of lower limb arterial angioplasty.
- To compare primary patency and amputation rates in patients who received statins before endovascular intervention versus those who did not.
Main Methods:
- A retrospective cohort study included 178 patients with CLI or limiting claudication undergoing lower limb percutaneous transluminal angioplasty.
- Patients were stratified based on preprocedural and in-hospital statin use.
- Outcomes, including primary patency and limb salvage rates, were analyzed using Kaplan-Meier and multivariate regression, adjusting for relevant clinical and procedural variables.
Main Results:
- Preprocedural statin use was not associated with improved primary patency rates at 1 year (73% in the overall cohort).
- After adjusting for factors like diabetes, disease location, and smoking status, preprocedural statin use showed no statistically significant difference in primary patency (HR: 0.87; P=0.79).
- Similarly, adjusted analysis revealed no significant difference in amputation rates associated with preprocedural statin use (HR: 0.70; P=0.22).
Conclusions:
- Preprocedural statin administration did not demonstrate a significant benefit in improving primary patency rates after peripheral angioplasty.
- The study concluded that statin use prior to peripheral angioplasty does not reduce amputation rates in patients with PAD.
Background:
Peripheral arterial disease can progress to critical limb ischemia, which is associated with high amputation rates and requires revascularization. The endovascular approach has lower long-term patency because of restenosis due to neointimal hyperplasia. Statins are significantly advantageous for patients undergoing percutaneous interventions; however, only few studies have reported surgical improvements with statin therapy after endovascular treatment in such patients. This retrospective cohort study assessed the effects of preprocedural statins on lower limb arterial angioplasty outcomes by evaluating patency and amputation rates and comparing with those without statins.
Methods:
Patients who underwent percutaneous transluminal angioplasty of the lower limbs for critical ischemia of the lower limbs or for limiting claudication were included in this retrospective cohort study. Patients were categorized according to statin use prior to and during hospitalization. Patient demographics, lesion morphology, primary patency, and limb salvage rates were compared between these groups. Statistical analyses were performed using Kaplan-Meier and multivariate regression analysis.
Results:
A total of 178 patients undergoing endovascular intervention by critical ischemia or limiting claudication were included. Approximately 80% of the procedures were ballon angioplasty. Primary patency was 73% in 1 year and preprocedural statin usage was not associated with improved primary patency rates (P = 0.2798). After adjusting the amputation outcomes for pre-established variables, such as prehospitalization statin use, diabetes, procedure indication, disease location, Trans-Atlantic Inter-Society Consensus classification, and current smoking, there was no statistically significant difference associated with preprocedural statin use in primary patency (hazard ratio: 0.87 [0.33-2.29], P = 0.79) or amputation (hazard ratio: 0.70 [0.40-1.23], P = 0.22).
Conclusions:
The use of preprocedural statin did not improve primary patency or amputation rates in patients undergoing peripheral angioplasty.
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