The Impact of Preprocedural Statin Use on Acute Kidney Injury and Mortality in Patients Undergoing Peripheral Vascular Intervention

Abstract

Current evidence suggests that statins may be protective against acute kidney injury (AKI) following angiography. We sought to assess the effect of statin use on outcomes following peripheral vascular intervention (PVI). We identified all patients undergoing PVI in the Vascular Quality Initiative (VQI) from 2003 to 2020 and excluded patients with history of dialysis or prior renal transplant. We compared postintervention outcomes in patients who were on preoperative statin medications to those who were not on a statin prior to PVI. Outcomes of interest were in-hospital AKI, myocardial infarction (MI), and in-hospital and 30-day mortality, assessed by multivariable logistic regression. Outcomes were also stratified by pre-existing chronic kidney disease (glomerular filtration rate [GFR] <60 and ≥60 mL/min/1.73m2). Among 110,266 patients, 81,807 (74%) were on preoperative statins and 28,459 (26%) were not. Patients receiving statins had lower rates of post-procedure AKI compared with those not taking statins (0.93% vs 1.1%; odds ratio [OR], 0.85; 95% confidence interval [CI], 0.74-0.97), as well as lower rates of in-hospital mortality (0.56% vs 1.0%; OR, 0.54; 95% CI, 0.47-0.63) and 30-day mortality (1.3% vs 2.4%; OR, 0.55; 95% CI, 0.49-0.61). After adjustment, statin use was associated with lower odds of AKI (adjusted OR [aOR], 0.79; 95% CI, 0.63-0.99), in-hospital MI (aOR, 0.65; 95% CI, 0.44-0.97), in-hospital mortality (aOR, 0.58; 95% CI, 0.43-0.78), and 30-day mortality (aOR, 0.68; 95% CI, 0.54-0.86). After stratifying by preoperative renal function, there was no association between statin usage and AKI in patients with normal GFR ≥60 mL/min/1.73m2 (aOR, 1.14; 95% CI, 0.20-6.31). However, in patients with GFR <60 mL/min/1.73m2, statin use was associated with 22% lower odds of developing AKI after PVI (aOR, 0.78; 95% CI, 0.62-0.98), as well as lower odds of in-hospital MI (aOR, 0.63; 95% CI, 0.42-0.95), in-hospital mortality (aOR, 0.56; 95% CI, 0.42-0.76), and 30-day mortality (aOR, 0.69; 95% CI, 0.54-0.87) (Table I). Pre-procedural statin use is associated with lower incidence of AKI following PVI, as well as lower in-hospital MI, in-hospital mortality, and 30-day mortality rates, particularly in patients with pre-existing renal dysfunction. Statins should be considered for renal protection prior to PVI, in addition to the current strategies of pre-hydration and minimization of contrast usage. Despite current guidelines and evidence of clinical benefits, statins continue to be significantly underused in the vascular population. Additional work is needed to improve the adoption of statins in patients with peripheral vascular disease.TableAdjusted odds ratios (aORs) for outcomes following peripheral vascular intervention (PVI) in patients on statins vs patients not on statins as reference groupEndpointPrimary cohort (N = 110,266)GFR ≥60 mL/min/1.73m2 (n = 70,752)GFR <60 mL/min/1.73m2 (n = 39,514)aOR [95% CI]P-valueaOR [95% CI]P-valueaOR [95% CI]P-valueIn-hospitalAKI0.79 [0.63-0.99].0450.14 [0.20-6.31].8830.78 [0.61-0.98].037In-hospitalMI0.65 [0.44-0.98].0380.81 [0.04-18.57].8960.63 [0.42-0.95].028In-hospital mortality0.58 [0.43-0.78]<.001a–0.56 [0.42-0.76]<.00130-day mortality0.68 [0.54-0.86].0010.04 [0.02-0.72]a.0290.69 [1.92-1.23].001AKI, Acute kidney injury; CI, confidence interval; GFR, glomular filtration rate; MI, myocardial infarction.All models adjusted for age, sex, race/ethnicity, smoking status, chrnic obstructive pulmonary disease, hypertension, diabetes, coronary artery disease, congestive heart failure, preoperative medications (aspirin, P2Y12 inhibitor, anticoagulation), procedure urgency, disease severity, contrast volume used, use of CO2 contrast, and use of contrast-induced nephritis prophylaxis; GFR was also included in the primary model.Boldface P-values indicate statistical significance.aAll in-hospital deaths occurred in patients not on statins in the normal GFR subgroup. Open table in a new tab