MORTALITY OVER A PERIOD OF 10 YEARS IN PATIENTS WITH PERIPHERAL ARTERIAL-DISEASE
MORTALITY OVER A PERIOD OF 10 YEARS IN PATIENTS WITH PERIPHERAL ARTERIAL-DISEASE
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DOI：
10.1056/nejm199202063260605
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发表时间：
1992-02-06
影响因子：
158.5
通讯作者：
BROWNER, D
中科院分区：
文献类型：
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作者：
CRIQUI, MH;LANGER, RD;BROWNER, D
背景以前的研究者已经观察到间歇性跛行患者的死亡率增加了一倍，我们已经报告了无创检测诊断的大血管外周动脉疾病患者的总死亡率增加了四倍。在这项研究中，我们调查了大血管外周动脉疾病与所有心血管疾病和冠心病死亡率的关系。我们检查了565名男性和女性（平均年龄66岁）的存在下，大血管外周动脉疾病的两种非侵入性技术测量节段性血压和多普勒超声测定血流速度。我们确定了67名患有这种疾病的受试者（11.9%），我们对他们进行了为期10年的前瞻性随访。在随访期间，患有大血管外周动脉疾病的34名男性中有21名（61.8%）和33名女性中有11名（33.3%）死亡，而没有外周动脉疾病证据的183名男性中有31名（16.9%）和225名女性中有26名（11.6%）死亡。在对年龄、性别和其他心血管疾病危险因素进行多变量校正后，与无大血管外周动脉疾病证据的受试者相比，大血管外周动脉疾病受试者死亡的相对风险为3.1（95%置信区间，1.9 - 4.9）全因死亡，5.9（95%置信区间，3.0至11.4）的所有心血管疾病死亡，6.6（95%置信区间，2.9至14.9）的冠心病死亡。在患有大血管外周动脉疾病的受试者中，死于心血管疾病以外原因的相对风险没有显著增加。在排除基线时有心血管疾病史的受试者后，大血管外周动脉疾病的相对风险仍然显著升高。进一步分析显示，在患有严重和恶性大血管外周动脉疾病的受试者中，心血管疾病和冠心病的死亡率增加了15倍。患有大血管外周动脉疾病的患者因心血管原因死亡的风险很高。
Background. Previous investigators have observed a doubling of the mortality rate among patients with intermittent claudication, and we have reported a fourfold increase in the overall mortality rate among subjects with large-vessel peripheral arterial disease, as diagnosed by noninvasive testing. In this study, we investigated the association of large-vessel peripheral arterial disease with rates of mortality from all cardiovascular diseases and from coronary heart disease.Methods. We examined 565 men and women (average age, 66 years) for the presence of large-vessel peripheral arterial disease by means of two noninvasive techniques measurement of segmental blood pressure and determination of flow velocity by Doppler ultrasound. We identified 67 subjects with the disease (11.9 percent), whom we followed prospectively for 10 years.Results. Twenty-one of the 34 men (61.8 percent) and 11 of the 33 women (33.3 percent) with large-vessel peripheral arterial disease died during follow-up, as compared with 31 of the 183 men (16.9 percent) and 26 of the 225 women (11.6 percent) without evidence of peripheral arterial disease. After multivariate adjustment for age, sex, and other risk factors for cardiovascular disease, the relative risk of dying among subjects with large-vessel peripheral arterial disease as compared with those with no evidence of such disease was 3.1 (95 percent confidence interval, 1.9 to 4.9) for deaths from all causes, 5.9 (95 percent confidence interval, 3.0 to 11.4) for all deaths from cardiovascular disease, and 6.6 (95 percent confidence interval, 2.9 to 14.9) for deaths from coronary heart disease. The relative risk of death from causes other than cardiovascular disease was not significantly increased among the subjects with large-vessel peripheral arterial disease. After the exclusion of subjects who had a history of cardiovascular disease at base line, the relative risks among those with large-vessel peripheral arterial disease remained significantly elevated. Additional analyses revealed a 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease that was both severe and symptomatic.Conclusions. Patients with large-vessel peripheral arterial disease have a high risk of death from cardiovascular causes.