Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival

Bjoern D. Suckow, Larry W. Kraiss, Andres Schanzer, David H. Stone, Jeffrey Kalish, Randall R De Martino, Jack L. Cronenwett, Philip P. Goodney

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)126-133
Number of pages8
JournalJournal of Vascular Surgery
Volume61
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Ischemia
Extremities
Survival
Amputation
Therapeutics
New England
Odds Ratio
Transplants
Survival Rate
Myocardial Infarction
Coronary Disease
Blood Vessels
Registries
Comorbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival. / Suckow, Bjoern D.; Kraiss, Larry W.; Schanzer, Andres; Stone, David H.; Kalish, Jeffrey; De Martino, Randall R; Cronenwett, Jack L.; Goodney, Philip P.

In: Journal of Vascular Surgery, Vol. 61, No. 1, 01.01.2015, p. 126-133.

Research output: Contribution to journalArticle

Suckow, Bjoern D. ; Kraiss, Larry W. ; Schanzer, Andres ; Stone, David H. ; Kalish, Jeffrey ; De Martino, Randall R ; Cronenwett, Jack L. ; Goodney, Philip P. / Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival. In: Journal of Vascular Surgery. 2015 ; Vol. 61, No. 1. pp. 126-133.
@article{a4cb712bd83f4aba9a3fda0582940d43,
title = "Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival",
abstract = "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.",
author = "Suckow, {Bjoern D.} and Kraiss, {Larry W.} and Andres Schanzer and Stone, {David H.} and Jeffrey Kalish and {De Martino}, {Randall R} and Cronenwett, {Jack L.} and Goodney, {Philip P.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2014.05.093",
language = "English (US)",
volume = "61",
pages = "126--133",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival

AU - Suckow, Bjoern D.

AU - Kraiss, Larry W.

AU - Schanzer, Andres

AU - Stone, David H.

AU - Kalish, Jeffrey

AU - De Martino, Randall R

AU - Cronenwett, Jack L.

AU - Goodney, Philip P.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84919416233&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919416233&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2014.05.093

DO - 10.1016/j.jvs.2014.05.093

M3 - Article

C2 - 25037607

AN - SCOPUS:84919416233

VL - 61

SP - 126

EP - 133

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 1

ER -