Five-Year Prognosis After Endovascular Therapy in Claudicant Patients With Iliofemoral Artery Disease
Five-Year Prognosis After Endovascular Therapy in Claudicant Patients With Iliofemoral Artery Disease
复制标题
DOI：
10.1583/13-4618r.1
复制
发表时间：
2014-06-01
影响因子：
2.6
通讯作者：
Ikeda, Uichi
中科院分区：
文献类型：
--
作者：
Miura, Takashi;Soga, Yoshimitsu;Ikeda, Uichi
目的：探讨血管内技术治疗间歇性跛行患者的预后。方法：一项回顾性多中心研究纳入了2930例连续的间歇性跛行患者（2307名男性，平均年龄71.5±8.9岁），这些患者因新发髂股动脉病变接受了血管内手术。主要结局指标是总生存期。次要结局是无主要不良心血管事件（MACE：全因死亡、心肌梗死和卒中）和无主要不良心血管和肢体事件（MACE伴有重复血运重建术或目标肢体膝上截肢）。对选定的基线特征、手术相关并发症和药物使用进行Cox多变量回归分析，以确定全因死亡率的预测因素。该分析的阳性预测因子用于将患者分为低危（1410例，48.1%）、中度（1406例，48.0%）和高危（114例，3.9%）三类。结果：1年、3年、5年总生存率分别为97.2%、90.8%、83.4%。42.8%的病例死于心血管疾病。1年、3年和5年MACE的解脱率分别为96.7%、88.6%和77.3%。Cox多因素回归分析发现，年龄、透析、左心室功能障碍、胰岛素依赖型糖尿病、血肿延长住院时间、冠状动脉疾病、股浅加髂病变是全因死亡率的积极预测因素。在风险分层分析中，高危患者的总体5年生存率明显低于其他组(90.1% vs. 78.6% vs. 53.5%, p
Purpose: To examine the prognosis of patients with intermittent claudication who received treatment with endovascular techniques.Methods: A retrospective multicenter study was performed involving 2930 consecutive patients (2307 men; mean age 71.5 +/- 8.9 years) with intermittent claudication who underwent an endovascular procedure for a de novo iliofemoral artery lesion. The primary outcome measure was overall survival. The secondary outcomes were freedom from major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and from major adverse cardiovascular and limb events (MACE with repeat revascularization or above-knee amputation of the target limb). Cox multivariate regression analysis of selected baseline characteristics, procedure-related complications, and medication use was performed to determine predictors for all-cause mortality. Positive predictors from this analysis were used to stratify patients into low- (1410, 48.1%), moderate- (1406, 48.0%), and high-risk (114, 3.9%) categories.Results: The overall survival rates were 97.2%, 90.8%, and 83.4% at 1, 3, and 5 years, respectively. The cause of death was cardiovascular in 42.8% of cases. Freedom from MACE was 96.7%, 88.6%, and 77.3% at 1, 3, and 5 years, respectively. Cox multivariate regression analysis identified age, dialysis, left ventricular dysfunction, insulin-dependent diabetes, hematoma prolonging hospitalization, coronary artery disease, and superficial femoral plus iliac lesions as positive predictors of all-cause mortality. In the risk stratification analysis, the overall 5-year survival rate was significantly lower in high-risk patients compared to the other groups (90.1% vs. 78.6% vs. 53.5%, p