Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival.
Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival.
复制标题
因严重肢体缺血而进行腹股沟旁路手术后的他汀类药物治疗与改善 5 年生存率相关。
DOI：
10.1016/j.jvs.2014.05.093
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发表时间：
2015
影响因子：
4.3
通讯作者：
VascularStudyGroupofNewEngland
中科院分区：
文献类型：
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作者：
Suckow,BjoernD;Kraiss,LarryW;Schanzer,Andres;Stone,DavidH;Kalish,Jeffrey;DeMartino,RandallR;Cronenwett,JackL;Goodney,PhilipP;VascularStudyGroupofNewEngland
尽管他汀类药物治疗与腹股沟下旁路术后短期并发症较少有关，但其对长期生存的影响仍不清楚。因此，我们检查了他汀类药物的使用与腹股沟下旁路手术后的长期死亡率、移植物闭塞和截肢之间的相关性。方法我们使用新英格兰登记处血管研究小组研究了2067名患者（71%男性;平均年龄，67 ± 11岁; 67%患有严重肢体缺血[CLI]），这些患者在2003年至2011年间接受了腹股沟下旁路手术。其中，1537例（74%）在围手术期和1年随访时接受他汀类药物治疗，530例未接受他汀类药物治疗。我们检查了5年生存率1、1年截肢率、移植物闭塞率和围手术期心肌梗死率的粗略、调整和倾向匹配率。结果在手术时和1年随访时服用他汀类药物的患者更有可能患有冠心病（38%对22%;P< .001），糖尿病（51%对36%;P< .001），高血压（89%对77%;P< .001）和既往血运重建术（50%对38%;P< .001）。尽管有更高的合并症负担，但使用他汀类药物患者的长期生存率在粗分析（风险比[RR]，0.7;P<0.001）、校正分析（风险比，0.7;P= 0.001）和倾向匹配分析（风险比，0.7;P= 0.03）中更好。在亚组分析中，他汀类药物治疗CLI患者的生存优势明显（5年生存率，63% vs 54%;对数秩，P= .01），但跛行患者的生存优势不明显（5年生存率，84% vs 80%;对数秩，P= .59）。在CLI患者中，他汀类药物治疗与1年大截肢率（12% vs 11%;P= 0.84）或移植物闭塞率（20% vs 18%;P= 0.58）无关。围手术期心肌梗死发生率更高的患者在他汀类药物的粗分析（RR，2.2;P= 0.01），但不是在匹配的队列（RR，1.9;P= 0.17）。结论他汀类药物治疗与CLI患者腹股沟下旁路术后5年生存率的好处。然而，在我们对新英格兰接受血运重建的患者进行的大型观察队列中，他汀类药物的使用对1年肢体相关结局没有影响。
ObjectiveAlthough 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.MethodsWe 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.ResultsPatients 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).ConclusionsStatin 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.