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Statins Reduce Mortality And Failure To Rescue after Myocardial Infarction Following Aortobifemoral Bypass In Aortoiliac Occlusive Disease Patients
Ahmed H. Abdelkarim, MBChB, Hanaa Dakour Aridi, MD, Merve Gurakar, BA, Besma Nejim, MBChB, MPH, Satinderjit Locham, MD, Mahmoud B. Malas, MD, MHS.
Johns Hopkins University, Baltimore, MD, USA.

Objective: The benefit of statins in reducing perioperative cardiovascular events in patients undergoing supra-inguinal bypass is still controversial. The purpose of this study is to evaluate the association between statin use and mortality in patients undergoing Aortobifemoral bypass (ABFB) for Aortoiliac Occlusive Disease (AIOD).
Method: We retrospectively analyzed all patients who had ABFB in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2015. Univariate(t-test, Chi-square or Fisher exact test) and multivariate logistic regression were used to compare patient characteristics and to evaluate 30-day mortality, myocardial infarction(MI) and post-MI failure to rescue (FTR),defined as mortality after MI, between statin users and non-statin users.
Results: A total of 3,157 patients underwent ABFB. Of those, 2145 (67.9%) were on statins. The majority of patients were males (60%) and white (65.2%). Statins users were older [Median (IQR): 66 (59, 73)vs.63(56, 72);P <0.01], more likely to be diabetic (30% vs. 17%), hypertensive (83% vs. 63%) and with history of prior bypass (27% vs. 21%) (all P<0.05) compared to non-statin users. Statin users had lower rates of 30-day mortality (3% vs.5%, p<0.01) and FTR following MI (14% vs. 29%,P=0.10) as compared to non-statin users (Table 1). After adjusting for patientsí demographics (age, sex, race), comorbidities (diabetes, hypertension,CHF,COPD,dialysis, prior bypass), aspirin and beta blocker usage, presentation(intermittent claudication vs. critical limb ischemia) and emergency status, statin use was associated with 42% reduction in 30-day mortality (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.37-0.91; P=0.02) and 81% reduction in failure to rescue after MI (OR: 0.19, 95%CI: 0.04-0.93;P=0.04). After stratifying by emergency status, statin use was shown to reduce the odds of 30-day mortality by 44% [n=2832,OR (95%CI):0.56(0.33-0.94),P = 0.03] in non-emergent cases, compare to 63% [n=325,OR (95%CI): 0.37(0.17-0.84),P =0.02] in emergent cases.
Conclusion: This is the largest study to show a strong protective effect of statins in patients undergoing ABFB for AIOD revascularization manifested by lower rates of 30-day mortality and a dramatic rescue phenomenon in patients who develop MI. This benefit is magnified in patients with emergent presentation.

Table 1.Analysis of 30-day outcomes in statin users vs. non-users
Univariate AnalysisMultivariate Analysis
Statin users
Non-statin users
P-valueOR95%CI P-value
Operative time (min), median (IQR)210(144.5-293.5)201(137-280)0.01
Length of stay (day), median (IQR)6(3-10)6(3-11)0.07
Return to OR285(13.3%)162(16%)0.04
Mortality 30 days65(3%)51(5%)<0.010.580.37-0.910.02
Failure to rescue after MI8(14%)8(29%)
Major Amputation34(1.6%)23(2.3%)0.170.740.40-1.380.34
CI,confidence interval; OR, odds ratio;IQR, interquartile range;MI,myocardial infarction.

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