Study Supports Statin Therapy Before EVAR Procedures

September 8, 2015— In Vascular, Edgar Luis Galiñanes, MD, et al published findings from an evaluation of the utilization of preoperative statins and their impact on perioperative outcomes in patients undergoing open repair or endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) (2015;23:344–349).

As summarized in Vascular, the investigators identified patients ≥ 50 years of age with nonruptured AAA repair in MedPAR files from 2007 to 2008 utilizing ICD-9-CM codes. Preoperative statin use was identified using National Drug Codes in Part D. Chi-square test, multivariable logistic regression, Kaplan-Meier, and Cox regression modeling were performed.

The investigators reported that 19,323 patients were identified undergoing AAA repair (14,602 EVAR and 4,721 open repair); of these, 9,913 (50.3%) used statins before surgery. Bivariate analysis demonstrated lower rates of hospital, 30-day, 90-day, and 1-year mortality in patients with statins compared to those without statins after EVAR (1% vs 1.45%; 1.51% vs 2.3%; 3.05% vs 4.66%; 7.91% vs 11.56%, respectively). 

Multivariable logistic regression adjusting for age, gender, race, comorbidities, and procedure demonstrated preoperative statins use was associated with a mortality reduction at 90-days postoperatively (odds ratio [OR] = 0.8; 95% confidence interval [CI] 0.70–0.91; P = .0014) and 1-year postoperatively (OR = 0.76; 95% CI, 0.69–0.84; P = .0001).

With only half of the patients undergoing AAA repair prescribed preoperative statins, the investigators concluded that after adjustment, statins were significantly associated with improved survival 1 year after surgery and a decreased incidence of lower-extremity embolic complications after EVAR. These data support a beneficial role of statin use before surgery for patients undergoing AAA repair. The investigators advised that further prospective studies are needed to assess the benefit of statins in the perioperative period after 365 days.