Arinze Nkiruka, Farber Alik, Sachs Teviah, Patts Gregory, Kalish Jeffrey, Kuhnen Angela, Kasotakis George, Siracuse Jeffrey J
Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass; OptumLabs, Boston, Mass.
J Vasc Surg. 2018 Nov;68(5):1398-1405. doi: 10.1016/j.jvs.2018.02.035.
Statin use in patients with cerebrovascular disease undergoing carotid endarterectomy (CEA) has been advocated for prevention of stroke and cardiovascular events. However, the effect of statin therapy on long-term outcomes after CEA still needs to be delineated.
OptumLabs Data Warehouse, a comprehensive, longitudinal, real-world dataset with deidentified lives across claims and clinical information, was used to analyze the rates of stroke, myocardial infarction (MI), and statin use after CEA. Both duration and intensity of statin therapy were investigated.
There were 21,277 patients who underwent CEA from 2004 to 2014. The average age was 70 years, and 59.4% were male. The average Elixhauser index score was 4.2. Follow-up was a median of 2.4 years (range, 0.2-10.0 years). Long-term statin use was observed in 57.4%. Statin distribution included atorvastatin 35%, simvastatin 35%, pravastatin 11%, rosuvastatin 10%, and lovastatin 7%. The 30- and 90-day stroke rates were 1.3% and 2.2%, and the MI rates were 0.5% and 1.1%, respectively. Postoperative statin use was associated with a lower perioperative stroke rate at 30 days (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.61-0.98; P = .036) and 90 days (OR, 0.75; 95% CI, 0.62-0.90; P = .002). Postoperative statin use did not show a protective effect on 30-day or 90-day MI rates (OR, 1.01; 95% CI, 0.69-1.46; P = .975) or 90-day MI rates (OR, 0.85; 95% CI, 0.66-1.11; P = .213). High-intensity statin use when compared with standard therapy did not affect 30-day stroke outcomes (OR, 0.96; 95% CI, 0.60-1.5; P = .847) or 90-day stroke outcomes (OR, 1.06; 95% CI, 0.74-1.5; P = .762); or 30-day MI (OR, 0.81; 95% CI, 0.39-1.68; P = .576) or 90-day MI (OR, 1.25; 95% CI, 0.79-1.96; P = .339). Statin use was independently protective against long-term stroke (hazard ratio, 0.82; 95% CI, 0.75-0.91; P < .001) and MI (hazard ratio, 0.83; 95% CI, 0.75-.92; P < .001).
Postoperative statin use among patients undergoing CEA was associated with a decreased risk of stroke at 30 and 90 days, as well as a long-term protective effect against MI and stroke. High-intensity statin use compared with standard use did not show an effect on outcomes of stroke or MI at 30 and 90-days after CEA.
对于接受颈动脉内膜切除术（CEA）的脑血管疾病患者，已提倡使用他汀类药物来预防中风和心血管事件。然而，他汀类药物治疗对CEA术后长期预后的影响仍有待明确。
OptumLabs数据仓库是一个全面、纵向的真实世界数据集，包含去识别化的保险理赔和临床信息，用于分析CEA术后的中风、心肌梗死（MI）发生率以及他汀类药物的使用情况。研究了他汀类药物治疗的持续时间和强度。
2004年至2014年期间有21277例患者接受了CEA。平均年龄为70岁，男性占59.4%。平均埃利克斯豪泽指数评分为4.2。随访时间中位数为2.4年（范围0.2 - 10.0年）。观察到57.4%的患者长期使用他汀类药物。他汀类药物分布情况为：阿托伐他汀35%，辛伐他汀35%，普伐他汀11%，瑞舒伐他汀10%，洛伐他汀7%。30天和90天的中风发生率分别为1.3%和2.2%，MI发生率分别为0.5%和1.1%。术后使用他汀类药物与30天（优势比[OR]，0.77；95%置信区间[CI]，0.61 - 0.98；P = 0.036）和90天（OR，0.75；95% CI，0.62 - 0.90；P = 0.002）围手术期中风发生率较低相关。术后使用他汀类药物对30天或90天的MI发生率（OR，1.01；95% CI，0.69 - 1.46；P = 0.975）或90天的MI发生率（OR，0.85；95% CI，0.66 - 1.11；P = 0.213）未显示出保护作用。与标准治疗相比，高强度使用他汀类药物对30天中风结局（OR，0.96；95% CI，0.60 - 1.5；P = 0.847）或90天中风结局（OR，1.06；95% CI，0.74 - 1.5；P = 0.762）；或30天MI（OR，0.81；95% CI，0.39 - 1.68；P = 0.576）或90天MI（OR，1.25；95% CI，0.79 - 1.96；P = 0.339）均无影响。使用他汀类药物对长期中风（风险比，0.82；95% CI，0.75 - 0.91；P < 0.001）和MI（风险比，0.83；95% CI，0.75 - 0.92；P < 0.001）具有独立的保护作用。
接受CEA的患者术后使用他汀类药物与30天和90天时中风风险降低相关，以及对MI和中风具有长期保护作用。与标准使用相比，高强度使用他汀类药物对CEA术后30天和90天的中风或MI结局未显示出影响。
