| Popis: |
Statin therapy is recommended in all patients with peripheral arterial disease (PAD). Its impact on reduction in mortality has been well documented, yet effect on limb-specific outcomes has been less conclusive. Differences among PAD subgroups, or variability of statin use may contribute to the inconsistent findings. We evaluated statin use in patients who underwent peripheral endovascular intervention (PVI) for chronic limb threatening ischemia (CLTI) and its impact on overall survival (OS), amputation free survival (AFS) and limb salvage (LS) METHODS: The national VQI was queried for index PVI for CLTI during the period 2010-2016; follow-up through 2020. Demographics, co-morbidities, operative details, and follow-up (FU) status were recorded. Patients were categorized as E-Statin: Statin use pre-PVI through discharge(D/C) and follow-up (FU) or N-Statin: No statins pre-PVI, at D/C or any time during FU. Propensity Score Matched Model (PSM) was constructed. Groups were compared using Chi Sq, Kaplan Meier Survival (KM) and Cox regression analysis (Cox).There were 9,089 index PVI in 8,402 patients; E-Statin: 7149 index PVI in 6,591 patients; N-Statin: 1940 index PVI in 1811 patients. The mean age was 69 + 12 years and 58% were male. Statin use was associated with improved 3-year OS: E Statin: 92.9% + 0.9 vs. N Statin: 91.1% + 2.2%; P= .003; HR: Exp(B) (95% CI): .66(.44-.99); P=.047 and remained significant following PSM: E Statin: 95.1% + 0.2% vs. 90.8% + 0.3%; P= .02; HR: .50(.27-.92); P= .025. No significant differences in 3-year LS or AFS were noted between the pre-matched groups; LS: E Statin:83.7% + 0.8 vs. N Statin:84.0% + 1.7%; P = .89; HR: 1.09(.88-1.35); P= .44; AFS: E Statin: 77.2% + 1.1% vs. 76.1% + 2.5%; P= .17; HR: .97(.79-1.18); P= .74. or following PSM: AFS: 80.2% + 2.8% vs. 74.7% + 3.9%; P = .53, HR: .92(.72- 1.19); P= .54; LS 85.3% + 1.9% vs. 83.5% + 2.6%; P= .51, HR: 1.08(.83-1.4); P= .57. Statins significantly improved LS among those with renal failure: 67.8% + 2.6% vs. 59.7% + 4.4%; P= .003; HR: 56(.40-.79); P= .001.Statins are independently associated with improved overall survival in patients who undergo PVI for CLTI and should be considered for all barring intolerance. Statin use was associated with improved limb salvage in patients with ESRD. Additional research is needed in this area, particularly, the impact of statin therapy in high-risk CLTI subgroups. |
