Author/Authors :
Nallamothu، نويسنده , , Brahmajee K. and Tommaso، نويسنده , , Carl L. and Anderson، نويسنده , , H. Vernon and Anderson، نويسنده , , Jeffrey L. and Cleveland Jr.، نويسنده , , Joseph C. and Dudley، نويسنده , , R. Adams and Duffy، نويسنده , , Peter Louis and Faxon، نويسنده , , David P. and Gurm، نويسنده , , Hitinder S. and Hamilton، نويسنده , , Lawrence A. and Jensen، نويسنده , , Neil C. and Josephson، نويسنده , , Richard A. and Malenka، نويسنده , , David J. and Maniu، نويسنده , , Calin V. and McCabe، نويسنده , , Kevin W. and Mortimer، نويسنده , , James D. and Patel، نويسنده , , Manesh R. and Persell، نويسنده , , Stephen D. and Rumsfeld، نويسنده , , John S. and Shunk، نويسنده , , Kendrick A. and Smith Jr.، نويسنده , , Sidney C. and Stanko، نويسنده , , Stephen J. and Watts، نويسنده , , Brook، نويسنده ,
Abstract :
Objectives
m of this study was to determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients.
ound
an advanced form of peripheral arterial disease associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain.
s
iewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins.
s
s were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl vs. 96 ± 40 mg/dl, p < 0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all p values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL.
sions
s are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.
Keywords :
ACC/AHA/SCAI/AMA-PCPI/NCQA Performance Measures , ambulatory-level quality , Quality Indicators , Hospital quality , percutaneous coronary intervention , health policy and outcome research
