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Intensity of Statin Therapy is Associated with Reduced Mortality after Major Lower Extremity Amputation
Charles S. DeCarlo1, John Phair, MD2, Saadat Shariff, MD2, Larry A. Scher, MD2, David P. Slovut, MD, PhD2, Evan C. Lipsitz, MD2, Karan Garg, MD2.
1Albert Einstein College of Medicine, Bronx, NY, USA, 2Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY, USA.
OBJECTIVES: Above-knee amputations (AKA) and Below-knee amputations (BKA) are associated with high mortality rates. Statin therapy has been associated with improved cardiovascular outcomes. In this study, we examined the effects of intensity of statin therapy on 30-day and 90-day mortality in patients who have undergone a major lower extremity amputation.
METHODS: We conducted a retrospective chart review of all patients who underwent AKAs or BKAs with closure between November 2007 and November 2014. Independent predictors of 30-day and 90-day mortality were determined by multivariable logistic regression. Intensity of statin therapy was defined based on 2013 AHA/ACC Guidelines.
RESULTS: We identified 812 patients (AKA 325; BKA 487). The cohort consisted of 54% men and had a mean age of 68.7 ± 14.9. The overall 30-day mortality was 8.4% (AKA 13.5%; BKA 4.9%). The overall 90-day mortality was 15.4% (AKA 24.3%; BKA 9.45%). Independent predictors of 30-day mortality included age, AKA, occluded bypass graft, dialysis, and chronic kidney disease, stages 3 and 4. Independent predictors of 90-day mortality included age, dialysis, AKA, and coronary artery disease. Medium-intensity statin or high-intensity statin was independently protective against mortality. Low-intensity statins did not confer protection from mortality (Table 1).
CONCLUSIONS: AKA and BKA have historically been associated with high mortality rates. It is important to identify risk factors that predispose patients to early post-operative mortality. Medium-intensity or high-intensity statin therapy confers protection from 90-day mortality when compared to no statin or low-intensity statin therapy.
Table 1: Multivariate odds ratios (95% confidence interval) and p-values| Independent Predictors of 30-day Mortality | Multivariate Odds Ratio (95% Confidence Interval) | Multivariate P Value | | Independent Predictors of 90-day Mortality | Multivariate Odds Ratio (95% Confidence Interval) | Multivariate P Value | | Age | 1.02 (1.00-1.04) | 0.04 | Dialysis | 2.48 (1.50-4.04) | <0.01 | | AKA | 2.83 (1.62-5.04) | <0.01 | AKA | 2.58 (1.00-1.04) | <0.01 | | Occluded Bypass Graft | 2.89 (1.57-5.18) | <0.01 | Age | 1.02 (1.00-1.04) | 0.01 | | Dialysis | 2.40 (1.26-4.41) | <0.01 | Coronary Artery | 1.59 (1.04-2.47) | 0.04 | | CKD3 | 1.98 (1.09-5.32) | 0.03 | Medium/High-Intensity Statin | 0.44 (0.28-0.70) | <0.01 | | CKD4 | 2.49 (1.09-5.32) | 0.02 | | | |
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