Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Perioperative and Surgical Sciences, Umeå University, Umeå, Sweden.
Br J Surg. 2024 Jan 3;111(1). doi: 10.1093/bjs/znad383.
Patients with abdominal aortic aneurysms are at high risk of cardiovascular events. Although statin therapy is indicated for most of these patients, no specific recommendation regarding the intensity of therapy exists. The aim of this study was to assess the possible effect of statin therapy on survival of patients undergoing abdominal aortic aneurysm repair and to investigate if high-intensity statin therapy was superior to low-moderate-intensity therapy.
Data from nationwide Swedish registers on hospital admissions, operations, and medications for patients undergoing elective abdominal aortic aneurysm repair from 2006 to 2018 were collected. The effect of statin use was evaluated in three separate propensity score matched cohorts: perioperative mortality was analysed according to whether patients were on statins before abdominal aortic aneurysm repair or not; long-term survival was assessed according to whether patients were on statins during follow-up or not; and, for those on statins after surgery, long-term survival was analysed according to whether patients were on high-intensity or low-moderate-intensity statin therapy.
Preoperative statin use did not reduce 90-day perioperative mortality (OR 0.99, 95% c.i. 0.77 to 1.28), whilst there was a marked benefit regarding long-term survival for postoperative statin users (HR 1.43, 95% c.i. 1.34 to 1.54). High-intensity statin therapy had no advantage over low-medium-intensity statin therapy with regards to long-term survival (HR 1.00, 95% c.i. 0.80 to 1.25).
In this nationwide propensity score matched cohort study, preoperative statin treatment had no benefit regarding 90-day perioperative survival, but postoperative statin treatment markedly improved long-term survival. No additional benefit regarding high-dose statin treatment could be confirmed in this analysis.
患有腹主动脉瘤的患者存在发生心血管事件的高风险。尽管大多数此类患者需要他汀类药物治疗，但针对治疗强度尚无具体建议。本研究旨在评估他汀类药物治疗对接受腹主动脉瘤修复患者生存的可能影响，并探讨高强度他汀类药物治疗是否优于中低强度治疗。
从 2006 年至 2018 年，收集了全国性瑞典住院患者、手术和药物治疗登记处关于择期腹主动脉瘤修复患者的数据。使用倾向评分匹配的三个独立队列评估了他汀类药物的使用效果：根据患者在腹主动脉瘤修复前是否使用他汀类药物，分析围手术期死亡率；根据患者在随访期间是否使用他汀类药物，评估长期生存率；对于手术后使用他汀类药物的患者，根据是否使用高强度或中低强度他汀类药物治疗，分析长期生存率。
术前使用他汀类药物不能降低 90 天围手术期死亡率（OR 0.99，95%CI 0.77 至 1.28），而术后使用他汀类药物的患者具有明显的长期生存获益（HR 1.43，95%CI 1.34 至 1.54）。高强度他汀类药物治疗与中低强度他汀类药物治疗相比，在长期生存方面没有优势（HR 1.00，95%CI 0.80 至 1.25）。
在这项全国性倾向评分匹配队列研究中，术前他汀类药物治疗对 90 天围手术期生存没有益处，但术后他汀类药物治疗明显改善了长期生存。在这项分析中，无法证实高剂量他汀类药物治疗的额外获益。
