Preoperative Statin Therapy is Associated with Higher Five-Year Survival After Thoracic Endovascular Aortic Repair.
Statin use is associated with higher long-term survival following abdominal aortic aneurysm (AAA) repair. However, the association between statin use and survival following thoracic endovascular aortic repair (TEVAR) has not been established.We performed a review of prospectively collected data of all patients undergoing TEVAR in the Vascular Quality Initiative between 2014 and 2020. We excluded patients who were less than 18-years-old, presented for trauma, or had custom-manufactured/physician-modified devices. We evaluated the association between preoperative statin therapy and in-hospital mortality and complications as well as five-year mortality. We also analyzed the trend of preoperative statin use in elective cases over the past seven years. To account for nonrandom assignment to treatment, we used a propensity-score matching (PSM) for preoperative statin use based on patient characteristics, comorbidities, pathology, and urgency. We used logistic regression and Cox regression for short-term and five-year outcomes, respectively.Of 6,266 patients who underwent TEVAR and met inclusion criteria, 3,331 (53%) patients were taking a statin preoperatively, including 1,148 of 2,267 (64%) who were treated for aneurysmal disease. After PSM, there were 1,875 patients in each cohort. Preoperative statin use was associated with lower rates of any perioperative complication (16.7% vs 19.6%; OR .82; 95%CI .69-.97; P=.022). Overall, preoperative statin use was also associated with lower five-year mortality (18.8% vs 24.5% HR .74; 95%CI .63-.89; P=.001). When stratified by urgency, preoperative statin use was associated with lower five-year mortality in elective TEVAR (14.9% vs 22.4%; HR .62; 95% CI, .49-.79; P < .001) but not in urgent/emergent cases (27.4% vs 29.1%; HR .89; 95%CI .70-1.14; P=.37). When stratified by pathology, preoperative statin use was associated with significantly lower five-year mortality in patients with aneurysms (HR .63; 95%CI, .48-.83; P=.001). Although there was lower mortality in patients with dissections and “other” pathology as well, these differences did not reach statistical significance. Between 2014 and 2019, there was a significant increase in statin use among elective TEVARs, from 56% in 2014 to 64% of patients in 2019 (P=.007).Preoperative statin therapy is associated with lower perioperative complication rates and five-year mortality in patients undergoing TEVAR. All patients with known thoracic aortic pathology should receive statin therapy unless there are contraindications for the drug. In patients undergoing elective TEVAR, statin prescription percentage should be considered a quality metric and further implementation research should occur to improve preoperative statin use.
Authors: Benjamin G Allar, Nicholas J Swerdlow, Livia E V M de Guerre, Kirsten D Dansey, Chun Li, Grace J Wang, Virendra I Patel, Marc L Schermerhorn