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Statin therapy reduces mortality risk after revascularization in CLI
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Patients who received moderate- or high-intensity statin therapy 1 year after revascularization for chronic limb-threatening ischemia were more likely to survive long term, according to data presented at the Society for Vascular Surgery Vascular Annual Meeting.
Nicholas J. Swerdlow, MD, clinical fellow in surgery at Beth Israel Deaconess Medical Center, Marc L. Schermerhorn, MD, chief of the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center, and colleagues analyzed data from 1,195 patients with chronic limb-threatening ischemia, also known as critical limb ischemia (CLI), who underwent 1,336 first-time revascularization procedures from 2005 to 2014.
Statin intensity was classified according to the American College of Cardiology/American Heart Association guidelines and assessed from discharge to 1-year follow-up.
Follow-up data were available for 792 patients who underwent 884 revascularizations.
At 1 year, 19% of patients were not on statin therapy, 8.3% were on low-intensity statins, 47% were on moderate-intensity statins and 28% of patients were on high-intensity statins.
From discharge to 1 year, 60% of patients remained on stable statin therapy, whereas 12% were never on a statin, 12% had their statin intensity decreased or stopped completely, and 16% of patients had initiated statin therapy or had it increased.
Compared with patients who were not on statin therapy, the risk for mortality was lower in those on moderate- (HR = 0.61; 95% CI, 0.42-0.89) or high-intensity statin therapy (HR = 0.58; 95% CI, 0.39-0.88). The risk for mortality did not differ between the low-intensity statin therapy group and the no-statin therapy group (HR = 1.02; 95% CI, 0.56-1.85).
The risk for mortality was lower in patients who were on stable statin therapy (HR = 0.55; 95% CI, 0.36-0.84) or had it initiated or increased (HR = 0.51; 95% CI, 0.29-0.91) compared with those who were never on a statin after the procedure. This difference was not seen in patients whose therapy was stopped or decreased (HR = 0.82; 95% CI, 0.48-1.4).
“These results demonstrate the importance of not only discharging this population on high- or moderate-intensity statin therapy, but also of maintaining this therapy postoperatively,” Swerdlow and colleagues wrote in an abstract. – by Darlene Dobkowski
Reference:
Swerdlow NJ, et al. Abstract VESS27. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 20-23, 2018; Boston.
Disclosure: Swerdlow reports no relevant financial disclosures. Schermerhorn reports he has consulted for Abbott.