PMID- 36503021
OWN - NLM
STAT- MEDLINE
DCOM- 20230321
LR  - 20230321
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 91
DP  - 2023 Apr
TI  - Impact of Statins on Survival and Limb Salvage in Patients Undergoing Peripheral 
      Endovascular Intervention for Chronic Limb-Threatening Ischemia.
PG  - 20-27
LID - S0890-5096(22)00751-8 [pii]
LID - 10.1016/j.avsg.2022.11.010 [doi]
AB  - BACKGROUND: 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 Vascular Quality Initiative was 
      queried for the index PVI for CLTI during the period 2010-2016; follow-up (FU) 
      through 2020. Demographics, comorbidities, operative details, and FU status were 
      recorded. Patients were categorized as E-Statin: statin use pre-PVI through 
      discharge (D/C) and FU or N-Statin: No statins pre-PVI, at D/C or any time during 
      FU. The propensity score matched model (PSM) was constructed. Groups were 
      compared using chi-square, Kaplan-Meier survival and Cox regression analysis. 
      RESULTS: There were 9,089 index PVI in 8,402 patients; E-Statin: 7149 index PVI 
      in 6,591 patients; and 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 versus N Statin: 91.1% +/- 2.2%; P = 0.003; hazard 
      ratio (HR): Exp (B) (95% confidence interval): 0.66 (0.44-0.99); P = 0.047 and 
      remained significant following PSM: E Statin: 95.1% +/- 0.2% versus 90.8% +/- 0.3%; 
      P = 0.02; HR: 0.50 (0.27-0.92); P = 0.025. No significant differences in 3-year 
      LS or AFS were noted between the prematched groups; LS: E Statin: 83.7% +/- 0.8 
      versus N Statin: 84.0% +/- 1.7%; P = 0.89; HR: 1.09 (0.88-1.35); P = 0.44; AFS-E 
      Statin: 77.2% +/- 1.1% versus 76.1% +/- 2.5%; P = 0.17; HR: 0.97 (0.79-1.18); 
      P = 0.74. or following PSM: AFS: 80.2% +/- 2.8% vs. 74.7% +/- 3.9%; P = 0.53, HR: 
      0.92 (0.72-1.19); P = 0.54; LS 85.3% +/- 1.9% vs. 83.5% +/- 2.6%; P = 0.51, HR: 1.08 
      (0.83-1.4); P = 0.57. Statins significantly improved LS among those with renal 
      failure: 67.8% +/- 2.6% vs. 59.7% +/- 4.4%; P = 0.003; HR: 56 (0.40-0.79); P = 0.001. 
      CONCLUSIONS: Statins are independently associated with improved OS in patients 
      who undergo PVI for CLTI and should be considered for all barring intolerance. 
      Statin use was associated with improved LS in patients with end-stage renal 
      disease. Additional research is needed in this area, particularly, the impact of 
      statin therapy in high-risk CLTI subgroups.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Chang, Matthew
AU  - Chang M
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - O'Brien-Irr, Monica
AU  - O'Brien-Irr M
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Montross, Brittany
AU  - Montross B
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Dosluoglu, Hasan
AU  - Dosluoglu H
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY; VA Western NY Healthcare System, Buffalo, NY.
FAU - Harris, Linda
AU  - Harris L
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Dryjski, Maciej
AU  - Dryjski M
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Rivero, Mariel
AU  - Rivero M
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY; VA Western NY Healthcare System, Buffalo, NY.
FAU - Khan, Sikandar Z
AU  - Khan SZ
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY. Electronic address: sikandarzkhan@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20221209
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
SB  - IM
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Limb Salvage
MH  - Chronic Limb-Threatening Ischemia
MH  - Risk Factors
MH  - *Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects
MH  - *Endovascular Procedures/adverse effects
MH  - Treatment Outcome
MH  - Ischemia/diagnostic imaging/therapy
MH  - *Peripheral Arterial Disease/diagnostic imaging/therapy
MH  - Retrospective Studies
EDAT- 2022/12/13 06:00
MHDA- 2023/03/22 06:00
CRDT- 2022/12/12 08:58
PHST- 2022/08/28 00:00 [received]
PHST- 2022/09/25 00:00 [revised]
PHST- 2022/11/04 00:00 [accepted]
PHST- 2022/12/13 06:00 [pubmed]
PHST- 2023/03/22 06:00 [medline]
PHST- 2022/12/12 08:58 [entrez]
AID - S0890-5096(22)00751-8 [pii]
AID - 10.1016/j.avsg.2022.11.010 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Apr;91:20-27. doi: 10.1016/j.avsg.2022.11.010. Epub 2022 Dec 
      9.