2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
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DOI：
10.1016/j.jacc.2016.11.008
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发表时间：
2017-03-21
影响因子：
24
通讯作者：
Walsh, M. Eileen
中科院分区：
文献类型：
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作者：
Gerhard-Herman, Marie D.;Gornik, Heather L.;Walsh, M. Eileen
只要有可能，本指南中列出的建议都是基于证据的。2015年1月至9月，进行了初步的广泛证据审查，其中包括来自涉及人类受试者的研究的文献，以英语发表，并在MEDLINE(通过PubMed)、EMBASE、Cochrane图书馆、医疗保健研究和质量机构以及其他与该指南相关的选定数据库中进行索引。关键词包括但不限于：急性肢体缺血，血管成形术，踝臂指数，抗凝，抗血小板治疗，非典型腿部症状，降压/高血压，搭桥/搭桥/外科搭桥，西洛他唑，跛行/间歇性跛行，严重肢体缺血/严重肢体缺血，糖尿病，诊断测试，血管内治疗，运动康复/运动疗法/运动训练/有指导运动，下肢/足部创伤/溃疡，周围动脉疾病/周围动脉疾病/周围血管疾病/下肢动脉疾病，吸烟/戒烟，他汀类药物，支架和血管外科手术。编写委员会还审议了截至2016年9月在准则编写过程中发表的其他相关研究，并酌情将其添加到证据表中。《在线数据补编》中的最后证据表总结了编写委员会用来拟订建议的证据。此外，撰写委员会审查了之前由ACC和AHA(10，11)发表的与下肢垫相关的文件。本文件中所选和发表的参考文献具有代表性，但并非包罗万象。如前言所述，行政协调会/AHA准则方法规定委托一个独立的审查委员会处理系统审查问题(PICOTS格式)，以便为编写委员会提出的建议提供信息。所有其他准则建议(不是基于系统审查问题)也要经过广泛的证据审查程序。对于这一指南，撰写委员会与工作组和ERC主席一起确定了以下系统性综述问题：1)抗血小板治疗对有症状或无症状的下肢垫患者的心血管事件的预防是否有益？2)与最佳的药物治疗和运动训练相比，血运重建对跛行患者的功能结局和生活质量(QOL)有何影响？每个问题都是最近发表的系统性证据审查的主题(12-14)。这些证据审查的质量由ACC/AHA方法学家和一家签约支持这一过程的供应商(Doctor Evience[加利福尼亚州圣莫尼卡])评估。在用于现有证据审查的文献搜索结束日期之后，几乎没有实质性的随机或非随机研究发表，因此ERC得出结论，没有必要进行额外的系统性审查来解决这些关键问题。
The recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review, which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline, was conducted from January through September 2015. Key search words included but were not limited to the following: acute limb ischemia, angioplasty, ankle-brachial index, anticoagulation, antiplatelet therapy, atypical leg symptoms, blood pressure lowering/hypertension, bypass graft/bypass grafting/surgical bypass, cilostazol, claudication/intermittent claudication, critical limb ischemia/severe limb ischemia, diabetes, diagnostic testing, endovascular therapy, exercise rehabilitation/exercise therapy/exercise training/supervised exercise, lower extremity/foot wound/ulcer, peripheral artery disease/peripheral arterial disease/peripheral vascular disease/lower extremity arterial disease, smoking/smoking cessation, statin, stenting, and vascular surgery. Additional relevant studies published through September 2016, during the guideline writing process, were also considered by the writing committee, and added to the evidence tables when appropriate. The final evidence tables included in the Online Data Supplement summarize the evidence utilized by the writing committee to formulate recommendations. Additionally, the writing committee reviewed documents related to lower extremity PAD previously published by the ACC and AHA (10, 11). References selected and published in this document are representative and not all-inclusive. As stated in the Preamble, the ACC/AHA guideline methodology provides for commissioning an independent ERC to address systematic review questions (PICOTS format) to inform recommendations developed by the writing committee. All other guideline recommendations (not based on the systematic review questions) were also subjected to an extensive evidence review process. For this guideline, the writing committee in conjunction with the Task Force and ERC Chair identified the following systematic review questions: 1) Is antiplatelet therapy beneficial for prevention of cardiovascular events in the patient with symptomatic or asymptomatic lower extremity PAD? 2) What is the effect of revascularization, compared with optimal medical therapy and exercise training, on functional outcome and quality of life (QoL) among patients with claudication? Each question has been the subject of recently published, systematic evidence reviews (12–14). The quality of these evidence reviews was appraised by the ACC/AHA methodologist and a vendor contracted to support this process (Doctor Evidence [Santa Monica, CA]). Few substantive randomized or nonrandomized studies had been published after the end date of the literature searches used for the existing evidence reviews, so the ERC concluded that no additional systematic review was necessary to address either of these critical questions.