Kindzelski Bogdan A, Hanick Andrea L, Miletic Kyle G, Lowry Ashley M, Van Wagoner David, Blackstone Eugene H, Roselli Eric E
Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Aorta (Stamford). 2021 Aug;9(4):147-154. doi: 10.1055/s-0041-1730296. Epub 2021 Nov 8.
Patients undergoing surgery for thoracic aortic aneurysms receive statin therapy out of proportion to cardiovascular comorbidity. We sought to determine the prevalence of statin use among patients presenting for thoracic aortic aneurysm surgery and investigate its effect on outcomes.
From January 1, 2005 to January 1, 2011, 1,839 consecutive patients underwent aortic replacement for degenerative thoracic aortic aneurysm at Cleveland Clinic. Of these, 771 (42%) were on statins preoperatively. Statin users (vs. nonstatin users) were older (65 ± 11 vs. 56 ± 16 years) and had more hypertension (78 vs. 59%). Propensity matching based on 56 preoperative variables other than lipid levels was used to compare outcomes among 570 matched patient pairs (74% of possible pairs).
Propensity-matched statin and nonstatin users were aged 64 ± 11 years, 394 (69%) versus 387 (68%) were male, and 437 (77%) versus 442 (78%) had ascending aortic aneurysms, respectively. Overall, 25% of patients were followed for more than 8.2 years and 10% for more than 10 years. Perioperative outcomes were similar, including hospital mortality (11 [1.9%] vs. 5 [0.88%]) and stroke (22 [3.9%] vs. 13 [2.3%]), but 16 statin users (2.8%) versus 5 nonstatin users (0.88%) required temporary dialysis after surgery (= 0.02). At 6 years, 3.7% of statin users versus 5.1% of nonstatin users ([log-rank] = 0.5) underwent further aortic surgery, and at 10 years, mortality was 25% in both groups ( > 0.5).
Patients presenting for thoracic aortic aneurysm surgery frequently receive unnecessary statins. Additionally, statin use was associated with more postoperative renal failure, but not less intermediate-term risk for aortic reintervention or all-cause mortality after surgery. Therefore, presence of a thoracic aortic aneurysm should not be considered an indication for statin therapy in the absence of well-established indications.
接受胸主动脉瘤手术的患者使用他汀类药物治疗的比例与心血管合并症不成比例。我们试图确定接受胸主动脉瘤手术患者中他汀类药物的使用情况，并研究其对手术结果的影响。
从2005年1月1日至2011年1月1日，1839例连续性患者在克利夫兰诊所接受了退行性胸主动脉瘤的主动脉置换术。其中，771例（42%）术前使用他汀类药物。他汀类药物使用者（与非使用者相比）年龄更大（65±11岁对56±16岁），高血压患病率更高（78%对59%）。基于除血脂水平外的56个术前变量进行倾向匹配，以比较570对匹配患者（占可能配对的74%）的手术结果。
倾向匹配后的他汀类药物使用者和非使用者年龄均为64±11岁，男性分别为394例（69%）和387例（68%），升主动脉瘤患者分别为437例（77%）和442例（78%）。总体而言，25%的患者随访时间超过8.2年，10%的患者随访时间超过10年。围手术期结果相似，包括住院死亡率（11例[1.9%]对5例[0.88%]）和卒中（22例[3.9%]对13例[2.3%]），但术后16例他汀类药物使用者（2.8%）与5例非使用者（0.88%）需要临时透析（=0.02）。6年时，3.7%的他汀类药物使用者与5.1%的非使用者（[对数秩检验] = 0.5）接受了进一步的主动脉手术，10年时，两组死亡率均为25%（>0.5）。
接受胸主动脉瘤手术的患者经常接受不必要的他汀类药物治疗。此外，使用他汀类药物与更多的术后肾衰竭相关，但与主动脉再次干预的中期风险或术后全因死亡率降低无关。因此，在没有明确指征的情况下，胸主动脉瘤的存在不应被视为他汀类药物治疗的指征。
