Association between Statin Medications and Primary Patency and All-cause Mortality Rates in Patients with Chronic Mesenteric Ischemia

Abstract

The recent guidelines from the Society for Vascular Surgery recommend the use of statins following endovascular management of chronic mesenteric ischemia (CMI). These recommendations were extrapolated from the American Heart Association guidance for the treatment of atherosclerotic equivalent conditions such as coronary artery disease. No published evidence is available specifically for CMI. This study aims to investigate the impact of statins on primary patency rates and all-cause mortality following endovascular management for CMI. A single-center retrospective review of all patients who underwent endovascular interventions for CMI from 2003 to 2019 was performed. All patients underwent The patients were divided into two groups based upon the postintervention use of a statin. The no statin group includes patients documented to be on no statin or with adherence <50%. Patients in whom statin compliance could not be assessed were excluded. Kaplan-Meier estimation and Cox proportional hazards models were calculated. A total of 156 patients were included with a mean age of 71.0 ± 12.3 years and 109 (69.9%) were female. Sixty-eight (43.6%) patients were included in the statins group and 88 (56.4%) in the no statin group. Patients on statins had higher rates of coronary artery disease, congestive heart failure, hyperlipidemia, peripheral artery disease, and diabetes mellitus (P < .05 in all). In the statin group, 28 (41.8%) patients took high-intensity statins, with atorvastatin and simvastatin being the most commonly prescribed medications. The multivariate model showed that statin use was a protective factor from primary patency loss (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.21-0.97; P = .041) (Table), but not from all-cause mortality (HR, 1.40; 95% CI, 0.77-2.56; P = .27). Similarly, the Kaplan-Meier curve showed higher primary patency rate in the statin group compared to the no statin cohort (Figure). Active smoking and gender were not associated with loss of primary patency in this analysis (HR, 0.80; 95% CI, 0.38-1.69; P = .56) and (HR, 1.51; 95% CI, 0.73-3.12; P = .26), respectively. The use of statins following endovascular interventions for CMI is associated with improved primary patency. This finding provides the first CMI-specific evidence to support the current Society for Vascular Surgery recommendations on statin use post procedurally. The finding represents the foundation for a multicenter investigation to confirm our observation.TablePrimary patency loss: All, multivariable, and overallVariableLevelsNo.HR (95% CI)P valueStatin groupNonstatin921.00Statin880.45 (0.21-0.97).041Coronary artery diseaseNo931.00Yes870.58 (0.26-1.28).18Congestive heart failureNo1521.00Yes281.02 (0.35-3.01).97HyperlipidemiaNo751.00Yes1051.43 (0.67-3.02).35Peripheral arterial diseaseNo921.00Yes880.60 (0.30-1.20).15Diabetes mellitusNo1301.00Yes501.58 (0.74-3.35).23Preoperative medications: aspirinNo681.00Yes1121.18 (0.54-2.57).68Postoperative medications: aspirinNo561.00Yes1241.24 (0.53-2.87).62CI, Confidence interval; HR, hazard ratio.n = 180 vessels. Open table in a new tab