Diabetes mellitus and other cardiovascular risk factors in lower-extremity peripheral artery disease versus coronary artery disease: an analysis of 1,121,359 cases from the nationwide databases
Diabetes mellitus and other cardiovascular risk factors in lower-extremity peripheral artery disease versus coronary artery disease: an analysis of 1,121,359 cases from the nationwide databases
复制标题
DOI：
10.1186/s12933-019-0955-5
复制
发表时间：
2019-11-15
影响因子：
9.3
通讯作者：
Ikari, Yuji
中科院分区：
文献类型：
--
作者：
Takahara, Mitsuyoshi;Iida, Osamu;Ikari, Yuji
背景下肢外周动脉疾病（LE-PAD）和冠状动脉疾病（CAD）在病理学上都起源于动脉粥样硬化，它们在暴露于心血管危险因素方面的共同临床特征已被强调。然而，这两种心血管疾病（CVD）的比较数据，到目前为止缺乏。本研究的目的是直接比较LE-PAD血管内治疗（EVT）和经皮冠状动脉介入治疗（PCI）病例的临床特征。方法从2012年至2017年日本EVT和PCI的全国手术数据库（J-EVT和J-PCI）中提取数据。共分析了1，121，359例病例（103，887例用于严重肢体缺血[CLI]或间歇性跛行的EVT病例和1，017，472例用于急性冠状动脉综合征[ACS]或稳定型心绞痛的PCI病例）。使用逻辑回归模型的C统计量评价CVD之间临床特征的异质性，其中因变量是一种CVD与另一种CVD，解释变量是临床特征。当开发的模型完全区分两种CVD时，模型的C统计量（区分能力）将等于1，表明两种CVD的临床特征完全不同。另一方面，当两种心血管疾病的临床特征相同时，所开发的模型根本无法区分它们，C统计量等于0.5。结果LE-PAD患者的平均年龄为73.5 ± 9.3岁，CAD患者的平均年龄为70.0 ± 11.2岁（P < 0.001）。LE-PAD患者糖尿病和终末期肾病的患病率分别是CAD患者的1.96倍和6.39倍（均P < 0.001）。无论年龄组如何，均观察到较高的患病率。暴露于其他心血管风险因素和心血管风险聚集的可能性也因疾病而异。CLI和ACS之间患者特征的疾病间异质性尤其明显，C统计量等于0.833（95% CI 0.831-0.836）。结论：目前的研究是一项基于全国手术数据库的分析，证实了具有临床意义的LE-PAD和CAD预防血运重建之间的患者特征并不相同，而是有相当大的差异。
Background Lower-extremity peripheral artery disease (LE-PAD) and coronary artery disease (CAD) are both pathologically rooted in atherosclerosis, and their shared clinical features regarding the exposure to cardiovascular risk factors have been emphasized. However, comparative data of the two cardiovascular diseases (CVDs) were so far lacking. The purpose of this study was to directly compare the clinical profile between cases undergoing endovascular therapy (EVT) for LE-PAD and those undergoing percutaneous coronary intervention (PCI). Methods Data were extracted from the nationwide procedural databases of EVT and PCI in Japan (J-EVT and J-PCI) between 2012 and 2017. A total of 1,121,359 cases (103,887 EVT cases for critical limb ischemia [CLI] or intermittent claudication and 1,017,472 PCI cases for acute coronary syndrome [ACS] or stable angina) were analyzed. Heterogeneity in clinical profile between CVDs was evaluated using the C statistic of the logistic regression model for which dependent variable was one CVD versus another, and explanatory variables were clinical profile. When two CVDs were completely discriminated from each other by the developed model, the C statistic (discrimination ability) of the model would be equal to 1, indicating that the two CVDs were completely different in clinical profile. On the other hand, when two CVDs were identical in clinical profile, the developed model would not discriminate them at all, with the C statistic equal to 0.5. Results Mean age was 73.5 +/- 9.3 years in LE-PAD patients versus 70.0 +/- 11.2 years in CAD patients (P < 0.001). The prevalence of diabetes mellitus and end-stage renal disease was 1.96- and 6.39-times higher in LE-PAD patients than in CAD patients (both P < 0.001). The higher prevalence was observed irrespective of age group. The exposure to other cardiovascular risk factors and the likelihood of cardiovascular risk clustering also varied between the diseases. The between-disease heterogeneity in patient profile was particularly evident between CLI and ACS, with the C statistic equal to 0.833 (95% CI 0.831-0.836). Conclusions The current study, an analysis based on nationwide procedural databases, confirmed that patient profiles were not identical but rather considerably different between clinically significant LE-PAD and CAD warranting revascularization.