title: Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival.
abstract: OBJECTIVE
  Although 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Patients 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).
  
  
  CONCLUSIONS
  Statin 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.
authors.affiliation: Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: bjoern.suckow@hsc.utah.edu.
authors.forename: Bjoern D
authors.initials: BD
authors.lastname: Suckow
authors.affiliation: Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Kraiss
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.affiliation: Section of Vascular Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: David H
authors.initials: DH
authors.lastname: Stone
authors.affiliation: Division of Vascular Surgery, Boston University School of Medicine, Boston, Mass.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kalish
authors.affiliation: Section of Vascular Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Randall R
authors.initials: RR
authors.lastname: DeMartino
authors.affiliation: Section of Vascular Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.affiliation: Section of Vascular Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009511:New England; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors