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Statin therapy is associated with improved clinical outcomes in patients undergoing endovascular intervention for symptomatic peripheral arterial disease
Francesco A. Aiello, MD1, Gisberto Evangelisti, MD2, Andrew J. Meltzer, MD1, Ashley Graham, BS2, James F. McKinsey, MD3, Darren B. Schneider, MD2.
1New York Presbyterian Hospital: Columbia/Cornell Medical Center, New York, NY, USA, 2New York Presbyterian Hospital: Cornell Medical Center, New York, NY, USA, 3New York Presbyterian Hospital: Columbia University Medical Center, New York, NY, USA.
Statin therapy has proven clinical benefits in patients undergoing endovascular interventions for cerebral, abdominal and renal artery disease, and critical limb ischemia (CLI). The purpose of this study is to determine the effects of statin therapy on all patients undergoing peripheral intervention for symptomatic peripheral artery disease (PAD)
A retrospective review of all patients undergoing peripheral endovascular intervention for symptomatic PAD. All patients on a statin at the time of intervention were placed in the statin therapy group. Demographics, symptom status (claudication or CLI), lesion morphology, primary patency, primary assisted patency, secondary patency and overall mortality were compared between these two groups. Analysis was performed using multivariate regression and Kaplan-Meier analysis
955 patients (1110 number of limbs) underwent endovascular intervention for symptomatic PAD between 2004 and 2009. 412 patients were treated for claudication and 543 patients were treated for CLI. 522 patients (54%) were on a statin, statin therapy group, and 433 patients were not on statin therapy at the time of intervention. The statin therapy group had significantly higher rates of diabetes mellitus, hypercholesterolemia, coronary artery disease, congestive heart failure, history of myocardial infarction, and previous coronary artery bypass surgery. The two groups had similar lesion length, location, TASC classification, and intervention. The statin therapy group had no difference in primary patency rates but did have significantly improved primary assisted ( 77.8% vs. 69.1%; p=0.006) secondary patency (83.2% vs. 74.6%; p=0.002), limb salvage (86.0% vs. 72.8%; p=0.001) and overall mortality rates at 12, 24, and 36 months. Claudicants on statin therapy had improved mortality rates at 12 months but no significant difference in primary, primary assisted, or secondary patency rates at 12, 24, or 36 months while the CLI patients on statin therapy had significantly improved primary assisted, secondary patency, limb salvage and mortality rates at all time periods.
Patients receiving statin therapy at the time of intervention for treatment of symptomatic PAD have a statistically significantly improvement in patency, limb salvage and mortality rates seen at up to 36 months. The benefits of statin therapy were most pronounced in the CLI subgroup and patients in the claudication subgroup had improved survival, but not improved patency. Our findings suggest that statin therapy should be part of the treatment regimen for all patients undergoing intervention for PAD.
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