Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization
Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization
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DOI：
10.1016/j.jacc.2018.07.046
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发表时间：
2018-10-02
影响因子：
24
通讯作者：
Hiatt, William R.
中科院分区：
文献类型：
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作者：
Baumgartner, Iris;Norgren, Lars;Hiatt, William R.
背景：下肢血管重建术是外周动脉疾病(PAD)患者常见的治疗方法，但远期疗效尚不明确。目的分析Euclid(检查PAD中替卡格雷的使用)试验中的LER，以确定预测因素和心血管结果。方法将患者按是否接受后随机LER分组(n=1,738)和(n=12,147)。在单变量和简约型多变量模型中评估所有变量的显著性。主要终点是心肌梗死、缺血性中风或心血管死亡；主要不良肢体事件(男性)包括急性肢体缺血或主要截肢。结果随机后LER的发生率为12.5%，血管内LER的发生率为74.7%。血管内LERS手术在北美更频繁，而外科手术在欧洲更频繁。预测LER的独立因素是既往LER的先证者和类型、地理区域、肢体症状、糖尿病和吸烟。随机化后的LER与主要终点(危险比：1.6；95%可信区间：1.35至1.9；p<；0.0001)和男性(危险比：12.0；95%可信区间：9.47至15.30p<；0.0001)的风险增加有关。外科组LER术后主要终点的发生率在数字上高于外科组，但男性在外科组和血管内组相似。结论在欧几里德试验中，LER最常发生在血管内。接受LER手术后，主要终点的风险增加(手术组的事件发生率更高)，男性事件的风险显著增加(手术和血管内LER手术的事件发生率相似)。(一项比较替卡格雷和氯吡格雷对外周动脉疾病患者心血管效应的研究[Euclid]；NCT01732822)(J AM Coll心脏ol 2018；72：1563-72)(C)2018，由美国心脏病学会基金会提供。
BACKGROUND Lower extremity revascularization (LER) is a common treatment in patients with peripheral artery disease (PAD), but long-term outcomes are poorly defined.OBJECTIVES The aim was to analyze LER in the EUCLID (Examining Use of tiCagreLor In paD) trial to determine predictors and cardiovascular outcomes.METHODS Patients were grouped according to whether they received a post-randomization LER (n = 1,738) or not (n = 12,147). All variables were assessed for significance in univariable and parsimonious multivariable models. The primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death; major adverse limb events (MALE) included acute limb ischemia or major amputation.RESULTS A post-randomization LER occurred in 12.5% of patients and was an endovascular LER in 74.7%. Endovascular LERs were performed more often in North America, whereas surgical procedures occurred more frequently in Europe. Independent factors predicting LER were prior and type of prior LER, geographic region, limb symptoms, diabetes, and smoking. A post-randomization LER was associated with an increased risk for the primary endpoint (hazard ratio: 1.60; 95% confidence interval: 1.35 to 1.90; p < 0.0001) and MALE (hazard ratio: 12.0; 95% confidence interval: 9.47 to 15.30; p < 0.0001). Event rates for the primary endpoint after LER were numerically higher in the surgical subgroup, but MALE were similar between surgical and endovascular LER.CONCLUSIONS In the EUCLID trial, LER was most often endovascular. Following LER, there was an increased hazard for the primary endpoint (with higher event rates in the surgical group) and a markedly increased risk for MALE events (with similar event rates between surgical and endovascular LER procedures). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822) (J Am Coll Cardiol 2018; 72: 1563-72) (C) 2018 by the American College of Cardiology Foundation.