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STATIN THERAPY IS ASSOCIATED WITH INCREASED AMPUTATION FREE SURVIVAL AMONG PATIENTS WITH CRITICAL LIMB ISCHEMIA
2015 JACC March 21, 2017 Volume 69, Issue 11
Vascular Medicine STATIN THERAPY IS ASSOCIATED WITH INCREASED AMPUTATION FREE SURVIVAL AMONG PATIENTS WITH CRITICAL LIMB ISCHEMIA Moderated Poster Contributions Vascular Medicine Moderated Poster Theater, Poster Hall, Hall C Friday, March 17, 2017, 4:15 p.m.-4:25 p.m. Session Title: Optimizing Treatment of Peripheral Artery Disease Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1179M-07 Authors: Konstantinos Stavroulakis, Matthias Borowski, Giovanni Torsello, Arne Stachmann, Bisdas Theodosios, Department of Vascular Surgery, St. Franziskus Hospital GmbH, Muenster, Germany
Background: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity. However, current recommendations are extrapolated from non-specific high-risk populations due to the lack of dedicated CLI-studies. Our aim was to report on the effects of statin therapy on the clinical outcomes of CLI patients in the framework of CRITISCH registry.
Methods: This prospective multicenter registry analyzed the effectiveness of different first-line treatment strategies in 1200 consecutive CLI patients from 27 vascular centers. Type of therapy and medication were left at the discretion of the treating physician. The patients were divided into two groups based on the statin therapy. Treatment crossovers and non-adherent patients were excluded from this analysis. Primary composite endpoint of this study was amputation free survival (AFS). Major adverse cardiovascular events (MACE), time to death and time to major amputation were also analyzed. Results: Statin therapy was applied in 445 individuals (37%), 371 (31%) patients received no statins during the entire follow-up and 384 subjects were excluded from analysis. Patients on statins were more likely to be younger (P<0.001) and to have a history of coronary heart disease (P<0.001) or previous intervention at index limb (P<0.001). In the overall cohort statin therapy improved the AFS rate (Hazard Ratio (HR): 2.21 95% confidence Interval (CI) 1.6 to 2.9) and survival rate (HR: 2.5, 95%CI 1.51-4.14) but did not affect the major amputation rate (HR: 0.9, 95%CI 0.64-1.5). Statin effect on AFS was consistent among diabetics (HR: 2.26, 95%CI 1.38-3.69), patients with chronic kidney disease (HR: 1.9, 95%CI 1.15-3.13) or older than 75 years (HR: 2.05, 95%CI 1.24-3.41). Statins were associated with increased AFS after both endovascular (HR: 2.42, 95%CI 1.43-4.07) and bypass therapy (HR: 2.65, 95%CI 1.46-4.81). Higher rate of MACE was observed in patients not on statin therapy (Odds Ratio: 2.46; 95%CI 1.44-4.26).
Conclusions: Statins in CLI patients are associated with increased AFS, lower rates of mortality and MACE without improving the salvage rates of the affected limb. Clinical Trial: NCT01877252
Vascular Medicine STATIN THERAPY IS ASSOCIATED WITH INCREASED AMPUTATION FREE SURVIVAL AMONG PATIENTS WITH CRITICAL LIMB ISCHEMIA Moderated Poster Contributions Vascular Medicine Moderated Poster Theater, Poster Hall, Hall C Friday, March 17, 2017, 4:15 p.m.-4:25 p.m. Session Title: Optimizing Treatment of Peripheral Artery Disease Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1179M-07 Authors: Konstantinos Stavroulakis, Matthias Borowski, Giovanni Torsello, Arne Stachmann, Bisdas Theodosios, Department of Vascular Surgery, St. Franziskus Hospital GmbH, Muenster, Germany
Background: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity. However, current recommendations are extrapolated from non-specific high-risk populations due to the lack of dedicated CLI-studies. Our aim was to report on the effects of statin therapy on the clinical outcomes of CLI patients in the framework of CRITISCH registry.
Methods: This prospective multicenter registry analyzed the effectiveness of different first-line treatment strategies in 1200 consecutive CLI patients from 27 vascular centers. Type of therapy and medication were left at the discretion of the treating physician. The patients were divided into two groups based on the statin therapy. Treatment crossovers and non-adherent patients were excluded from this analysis. Primary composite endpoint of this study was amputation free survival (AFS). Major adverse cardiovascular events (MACE), time to death and time to major amputation were also analyzed. Results: Statin therapy was applied in 445 individuals (37%), 371 (31%) patients received no statins during the entire follow-up and 384 subjects were excluded from analysis. Patients on statins were more likely to be younger (P<0.001) and to have a history of coronary heart disease (P<0.001) or previous intervention at index limb (P<0.001). In the overall cohort statin therapy improved the AFS rate (Hazard Ratio (HR): 2.21 95% confidence Interval (CI) 1.6 to 2.9) and survival rate (HR: 2.5, 95%CI 1.51-4.14) but did not affect the major amputation rate (HR: 0.9, 95%CI 0.64-1.5). Statin effect on AFS was consistent among diabetics (HR: 2.26, 95%CI 1.38-3.69), patients with chronic kidney disease (HR: 1.9, 95%CI 1.15-3.13) or older than 75 years (HR: 2.05, 95%CI 1.24-3.41). Statins were associated with increased AFS after both endovascular (HR: 2.42, 95%CI 1.43-4.07) and bypass therapy (HR: 2.65, 95%CI 1.46-4.81). Higher rate of MACE was observed in patients not on statin therapy (Odds Ratio: 2.46; 95%CI 1.44-4.26).
Conclusions: Statins in CLI patients are associated with increased AFS, lower rates of mortality and MACE without improving the salvage rates of the affected limb. Clinical Trial: NCT01877252