(PC028) Impact of Statin Intensity on lower extremity revascularization outcomes in a tertiary care center

Objectives: Recent guidelines for peripheral arterial disease (PAD) recommend high intensity statin therapy targeting low density lipoprotein (LDL) < 55 mg/dL in patients with advanced PAD requiring lower extremity revascularization (LER). Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are novel medications suggested for patients who do not achieve LDL targets on maximal statin therapy. However, there is paucity of research pertaining to the intensity of statin therapy and the use of PCSK9i outside clinical trials. This study compares the outcomes of high intensity statin to low/moderate dosing in patients with PAD undergoing LER.

Methods: Retrospective chart review was performed for patients that underwent index LER from 2013-2020 at a tertiary care center with follow up to 2024. Patients treated with statins were divided based on initial statin intensity into high vs low/moderate. Characteristics, outcomes, LDL levels, as well as use of PCSK9i were compared between the 2 groups. Survival and regression analysis were performed.

Results: A total of 2,036 patients that underwent LER were reviewed and 92.8% (N=1,889) received statin therapy at some point within the study period. This analysis focuses on 1,647 patients that were treated with statin (52.7%, N=868 High Intensity) at the time of index intervention. Patients managed with High intensity statins were more likely to be younger, male and non-white, with higher rates of comorbidities and higher likelihood to receive antiplatelet medications. Only 20% of patients had a target LDL < 55 mg/dL at baseline but that proportion increased to 33% after a mean follow up of 4 years with no significant difference between the 2 groups. Initiation of PCKS9i was low in both groups. Perioperative morbidity and mortality were not different but patients on high intensity statin were more likely to have return to OR. After a mean follow up of 4.3 years, patients on high intensity statin had significantly higher major cardiovascular events (MACE) but lower mortality. (Table I) However, Kaplan-Meier analysis showed no difference in overall survival but higher freedom from MACE in patients with low/moderate intensity group. (Fig 1) Regression analysis revealed no association between statin intensity and outcomes.

Conclusions: Most patients with PAD undergoing LER receive statin therapy but only a third achieve the recommended LDL levels. Statin intensity does not seem to impact clinical outcomes or LDL targets. The use of PCSK9i remains very low and could improve LDL targets and clinical outcomes with wider implementation.