Division of Vascular Surgery, Department of Surgery, Johns Hopkins University Hospital, Baltimore, Md.
Division of Vascular Surgery, Department of Surgery, Johns Hopkins University Hospital, Baltimore, Md.
J Vasc Surg. 2019 Jan;69(1):112-119. doi: 10.1016/j.jvs.2018.03.424. Epub 2018 Jun 15.
The benefit of statins has been well established in reducing morbidities and mortality after carotid endarterectomy. However, the potential advantage of statin use in patients undergoing carotid artery stenting (CAS) remains largely unknown. The purpose of this study was to evaluate the effect of statins on postoperative outcomes after CAS.
The Premier Healthcare Database was retrospectively analyzed to identify all patients who underwent CAS from 2009 to 2015. Univariate (χ test, t-test) and multivariate models (logistic regression) were used to evaluate the effect of statins on postoperative outcomes.
A total of 17,800 patients underwent CAS during the study period; 12,416 (70%) patients were taking statins. The statin group had more symptomatic patients (41% vs 31%; P < .001) and had significantly higher comorbidities including hypertension, diabetes, coronary artery disease, dyslipidemia, history of congestive heart failure, history of stroke, history of myocardial infarction (MI), and peripheral artery disease (all P < .05). Postoperative mortality was 1.0% vs 1.8% in the statin and nonstatin groups, respectively (P < .001). Statin use had no effect on odds of postoperative stroke (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.88-1.34; P = .44) and higher odds of MI (OR, 2.08; 95% CI, 1.26-3.45; P = .004). After adjustment for potential confounders, statins were associated with 64% reduction in the odds of death (OR, 0.36; 95% CI, 0.27-0.47; P < .001) and 18% reduction in stroke/death (OR, 0.82; 95% CI, 0.68-0.99; P = .03). In patients who had a stroke or MI, statin users had significantly lower failure to rescue (lower mortality) compared with nonstatin users (11.4% vs 30.8%; P < .001).
Statin use is associated with significant reduction in mortality and failure to rescue in patients who develop major complications (stroke/MI) after CAS. Therefore, statin use should be strongly encouraged in all patients undergoing CAS.
他汀类药物在降低颈动脉内膜切除术（CEA）后的发病率和死亡率方面的益处已得到充分证实。然而，他汀类药物在颈动脉支架置入术（CAS）患者中的潜在优势仍知之甚少。本研究旨在评估他汀类药物对 CAS 术后结局的影响。
回顾性分析 Premier Healthcare Database，以确定 2009 年至 2015 年期间接受 CAS 的所有患者。使用单变量（卡方检验、t 检验）和多变量模型（逻辑回归）评估他汀类药物对术后结局的影响。
在研究期间，共有 17800 例患者接受了 CAS 治疗；其中 12416 例（70%）患者正在服用他汀类药物。他汀类药物组的症状性患者比例更高（41% vs 31%；P<0.001），且合并症显著更多，包括高血压、糖尿病、冠心病、血脂异常、充血性心力衰竭史、中风史、心肌梗死史和外周动脉疾病史（均 P<0.05）。他汀类药物组和非他汀类药物组的术后死亡率分别为 1.0%和 1.8%（P<0.001）。他汀类药物的使用对术后中风的发生几率没有影响（比值比 [OR]，1.09；95%置信区间 [CI]，0.88-1.34；P=0.44），但与心肌梗死（OR，2.08；95% CI，1.26-3.45；P=0.004）的几率更高相关。在校正潜在混杂因素后，他汀类药物与死亡几率降低 64%相关（OR，0.36；95% CI，0.27-0.47；P<0.001），与中风/死亡几率降低 18%相关（OR，0.82；95% CI，0.68-0.99；P=0.03）。在发生中风或心肌梗死的患者中，与非他汀类药物使用者相比，他汀类药物使用者的抢救失败率（死亡率较低）显著降低（11.4% vs 30.8%；P<0.001）。
在 CAS 后发生主要并发症（中风/心肌梗死）的患者中，他汀类药物的使用与死亡率和抢救失败率的显著降低相关。因此，应强烈鼓励所有接受 CAS 的患者使用他汀类药物。
