Abstract 117: Statin Use Improves Limb Salvage After Intervention for Peripheral Arterial Disease

Abstract

Background: Statin use is recommended in patients with peripheral arterial disease (PAD) due to its morbidity and mortality benefits. However, the effect of statins on limb salvage in PAD is unclear. We examined the effect of statins on survival and limb salvage among PAD patients undergoing surgical or endovascular intervention. Methods: PAD patients were identified who underwent intervention between 2009 and 2010. Information was collected from electronic medical records and the Social Security Death Index. Univariate analysis was used to determine predictors of ongoing statin use. Survival and freedom from amputation were determined using KM plots and adjusted hazard ratios by Cox regression. Results: A total of 488 PAD patients underwent surgical (n=297) or endovascular (n=191) intervention. 39% were African-American, 44% were female, 41% received statins, 56% received antiplatelet medications, 26% received oral anticoagulants, 9% required a major amputation, and 11% died during follow-up of up to 88 months. Statin users were more often male (p=0.03), caucasian (p=0.03), smokers (p<0.01), and had higher comorbidities such as CAD (p<0.01), hypertension (p<0.01), and diabetes (p<0.01). Antiplatelet use was not associated with amputations (p=0.13), but did lower mortality (p<0.01). Dual antiplatelet therapy did not show any benefit over monotherapy for mortality (p=0.3) or amputations (p=0.4). Statin use was associated with lower mortality (p=0.04), and improved limb salvage (hazard ratio, 0.3; 95% confidence interval, 0.2-0.6) after adjusting for severity of disease as well as antiplatelet and anticoagulation use. Conclusion: Statin use in PAD patients with interventions was associated with improved limb-salvage and survival. Despite existing guidelines, statin therapy was disappointingly low in our PAD population, and efforts will be made to increase use across our health system.