Continuous ACE Inhibitor Use Is Associated With Improved Perioperative and Long-term Mortality Benefit in Patients Undergoing Lower Extremity Bypass for Peripheral Arterial Disease

Introduction: Restoring circulation to patients with symptomatic lower extremity peripheral arterial disease (PAD) is traditionally achieved with open surgery. However, endovascular techniques have enhanced the armamentarium available to patients. No long-term, population-based results exist on which of these provides the optimal approach to symptomatic PAD. Methods: We identified patients who underwent an inpatient endovascular or open lower extremity revascularization for PAD (including those with claudication and limb threat) for 2006 through 2009 from the Centers for Medicare & Medicaid Services Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries. The primary outcome was amputation free survival. The secondary outcome was the relative rate of subsequent intervention. Propensity score matching ensured similar baseline characteristics amongst cohorts. Results: Among 14,685 eligible patients, 5,928 endovascular revascularization patients and 5,928 open revascularization patients were included in a matched analysis. Patients undergoing endovascular repair had improved amputation free survival compared to open repair at 30-days (7.4 vs. 8.9%, p=0.002). This benefit persisted over the long-term: At 4-years, 49% of endovascular patients had died or received major amputation compared to 54% of open patients (p<0.001). An endovascular procedure was associated with a risk-adjusted 19% decreased risk of amputation or death compared to open over the study period (hazard ratio: 0.84; 95% confidence interval, 0.79-0.89; p<0.001). The rate of subsequent intervention at 30-days was 7.4% greater for the endovascular versus the open revascularization cohort. At 4-years, this difference remained stable at 8.6%. Conclusions: Using a population-based dataset, we show that an endovascular approach is associated with improved amputation free survival over the long-term. Moreover, we show a modest initial increase in the risk of reintervention after endovascular procedures; the differential rate of reintervention for endovascular patients was less than 10% over four years. The observed benefit associated with endovascular intervention may have significant implications for the millions of patients with PAD.

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Long‐Term Prognostic Risk in Lower Extremity Peripheral Arterial Disease as a Function of the Number of Peripheral Arterial Lesions

Journal of the American Heart Association ◽

10.1161/jaha.115.001823 ◽

2015 ◽

Vol 4 (10) ◽

Cited By ~ 3

Author(s):

Kim G. Smolderen ◽

Moniek van Zitteren ◽

Philip G. Jones ◽

John A. Spertus ◽

Jan M. Heyligers ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Lower Extremity ◽

Arterial Disease ◽

Arterial Lesions ◽

Peripheral Arterial

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A Prognostic Risk Index for Long-term Mortality in Patients With Peripheral Arterial Disease

Archives of Internal Medicine ◽

10.1001/archinte.167.22.2482 ◽

2007 ◽

Vol 167 (22) ◽

pp. 2482 ◽

Cited By ~ 49

Author(s):

Harm H. H. Feringa

Keyword(s):

Peripheral Arterial Disease ◽

Risk Index ◽

Arterial Disease ◽

Peripheral Arterial ◽

Long Term Mortality

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Initial Diastolic Dysfunction is a Powerful Predictor of 5-year Mortality in Peripheral Arterial Disease Patients undergoing Percutaneous Transluminal Angioplasty

10.21203/rs.3.rs-41677/v1 ◽

2020 ◽

Author(s):

Kyung-Hee Kim ◽

Seung Woon Rha ◽

Byoung Geol Choi ◽

Jae-Kyung Byun ◽

Woohyeun Kim ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Percutaneous Transluminal Angioplasty ◽

Independent Predictor ◽

Arterial Disease ◽

Transluminal Angioplasty ◽

Total Death ◽

Peripheral Arterial ◽

Percutaneous Transluminal ◽

Long Term Mortality

Abstract Background Peripheral arterial disease (PAD) and heart failure share common risks and are associated with increased morbidity and mortality. However, it is unknown whether cardiac function can be an independent predictor of long-term mortality in patients with PAD. Methods In total, 902 patients who underwent percutaneous transluminal angioplasty for PAD were enrolled. The patients were categorized into three groups according to the left ventricular ejection fraction (LVEF): reduced EF (< 40%, n = 62); mid-range EF (40–49%, n = 76); and preserved EF (≥ 50%, n = 764). Echocardiographic (EF, ratio of mitral inflow velocity to annular velocity E/eʹ ≥ 15, and others) and clinical parameters were tested using stepwise logistic regression analysis to determine independent predictors of 5-year mortality. Results A higher proportion of patients with reduced EF had ischemic heart disease than those with preserved EF (77.4% vs. 56.8%, p < 0.001). Up to 5 years, patients with reduced EF and mid-range EF showed a higher incidence of total death than those with normal EF. However, there was no difference in the incidence of myocardial infarction, stroke, and revascularization among the three groups. After multivariable adjustment, the ratio of E/eʹ ≥ 15 was the only strong predictor of total mortality (hazard ratio, 6.14; 95% confidence interval, 3.7–10.1;p < 0.01). Conclusion Patients with PAD and reduced EF undergoing PTA had a higher incidence of total death during the 5-year follow-up. Initial tissue Doppler E/eʹ ≥ 15, a non-invasive estimate of left atrial filling pressure, was the only independent predictor of long-term mortality.

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