Bjoern D. Suckow1, Larry W. Kraiss1, Andres Schanzer3, David H. Stone2, Jeffrey Kalish4, Randall R. DeMartino2, Jack L. Cronenwett2, Philip P. Goodney2
1University of Utah School of Medicine, Salt Lake City, UT; 2Dartmouth Medical School, Hanover, NH; 3University of Massachusetts Medical School, Worcester, MA; 4Boston University School of Medicine, Boston, MA.
OBJECTIVES: While statin therapy has been linked to fewer short-term complications after lower extremity bypass (LEB), its effect on long-term survival in such patients is uncertain. Therefore, we examined associations between statin use and long-term mortality after LEB.
METHODS: We used the Vascular Study Group of New England registry to study 2,067 patients (71% male, mean age 67 yrs, 67% with CLI) who underwent infrainguinal bypass from 2003-2011. Of these, 1,537 (74%) were on statins peri-operatively and at 1-yr follow-up, while 530 received no statin. We examined crude, adjusted and propensity-matched 5-yr survival (via Social Security Death Index), and 1-yr amputation and graft occlusion rates.
RESULTS: Patients on statins had more coronary disease (38% vs. 22%, p<0.001), diabetes (51% vs. 36%, p<0.001), hypertension (89% vs. 77%, p<0.001) and prior revascularization procedures (50% vs. 38%, p<0.001). Despite higher comorbidity burdens, long-term survival was better for patients on statins in crude (RR=0.7, p<0.001), adjusted (HR=0.7, p=0.001) and propensity- matched analyses (HR=0.7, p=0.03, Figure). In subgroup analysis, a survival advantage was evident in patients with CLI, but not claudication. Statin therapy did not affect 1-yr rates of major amputation (12% vs. 11%, p=0.84) or graft occlusion (20% vs. 18%, p=0.58) in CLI patients.
CONCLUSIONS: While statin therapy confers a five-year survival benefit following LEB, one-year limb-related outcomes are not influenced by statin use.
AUTHOR DISCLOSURES: J. L. Cronenwett, Nothing to disclose; R. R. DeMartino, Nothing to disclose; P. P. Goodney, Nothing to disclose; J. Kalish, Nothing to disclose; L. W. Kraiss, Nothing to disclose; A. Schanzer, Nothing to disclose; D. H. Stone, Nothing to disclose; B. D. Suckow, Nothing to disclose.
Isolated effect of statin on survival based on the propensity-matched cohort.
Posted April 2012