Highlights
- •Statins are associated with improved overall survival in chronic limb-threatening ischemia.
- •Statins are associated with improved limb salvage (LS) in patients with end-stage renal disease.
- •An impact on LS and amputation-free survival outcomes by statins could not be shown.
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.
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Article info
Publication history
Published online: December 08, 2022
Accepted:
November 4,
2022
Received:
August 28,
2022
Footnotes
Declaration of interests: None declared.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
