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. Demartino, Jack L. Cronenwett, Philip P. Goodney

Research output: Contribution to journalArticle

39 Scopus citations

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.e1
JournalJournal of vascular surgery
Volume61
Issue number1
DOIs
StatePublished - Jan 1 2015

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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