Abstract 13304: Statin Therapy is Not Indicated for Thoracic Aneurysm Alone
Objectives: Statins’ effects extend beyond lipid lowering. Their role in treating thoracic aortic aneurysms (TAA) remains unclear. Our objectives were to 1) characterize preoperative statin use among TAA patients and 2) investigate statins’ effect on outcomes after open repair.
Methods: From 1/2005 to 1/2011, 4,683 patients underwent thoracic aortic surgery at the Cleveland Clinic, including 958 open repairs for degenerative TAA (root 23%, ascending 85%, arch 21%, descending /thoracoabdominal 11%); 47% had a bicuspid aortic valve. Three hundred eighty-eight (41%) took statins preoperatively. Propensity matching was used to compare 274 pairs of statin users and non-users.
Results: Statin users were older (65±11 vs. 56±16 years), had lower cholesterol (164±32 vs. 189±36 mg/dL), and more hypertension (75% vs. 58%), carotid disease (41% vs. 28%), diabetes (12% vs. 4.4%), and myocardial infarctions (21% vs. 8.4%). Hospital mortality, stroke prevalence, and length of stay were higher in statin users (2.8% vs. 0.7%, P=.009; 3.4% vs. 1.4%, P=.04; and median 7.1 vs. 6.8 days, P=.002, respectively), but differences were not maintained after matching. Renal failure, however, was higher in statin users before and after matching (6.2% vs. 1.8%; P=.009, matched). During follow-up, 32 matched patients had aortic reinterventions, with similar prevalence ( P=.9; Figure). Matched patients also experienced similar survival (P=.7; Figure).
Conclusions: Thoracic aneurysm surgical patients frequently receive statins for cardiovascular comorbidities. However, statins may increase risk of perioperative renal failure without lowering intermediate risk for aortic reintervention or improving survival after TAA surgery. Therefore, TAA alone should not be considered an indication for statin therapy in surgical patients.
- © 2013 by American Heart Association, Inc.