Major Adverse Limb Events and 1-Year Outcomes After Peripheral Artery Revascularization
Major Adverse Limb Events and 1-Year Outcomes After Peripheral Artery Revascularization
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DOI：
10.1016/j.jacc.2018.06.041
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发表时间：
2018-08-28
影响因子：
24
通讯作者：
Hiatt, William R.
中科院分区：
文献类型：
--
作者：
Hess, Connie N.;Rogers, R. Kevin;Hiatt, William R.
背景 血运重建对于外周动脉疾病的症状治疗和保肢很重要，但关于术后主要不良肢体事件 (MALE) 的发生率和长期结局的数据很少。 目的 本研究旨在描述外周动脉血运重建后住院和门诊血管内血运重建的特征，评估结果的时间趋势，并确定与随后的 MALE 住院相关的因素。 方法 2009 年 1 月 1 日至 9 月期间接受外周动脉血运重建的患者2014 年 2 月 30 日，在高级医疗保健数据库中检查了 1 年男性住院的主要结果。次要结局包括 1 年门诊血管内血运重建以及肢体相关、心血管和全因住院治疗。使用多变量逻辑回归来确定与 1 年 MALE 住院相关的因素。 结果 在 381,415 名接受血运重建的患者中，指数血运重建后 1 年内，10.3% (n = 10,182) 因 MALE 住院，11.0% (n = 42,056) 接受门诊血管内血运重建，18.8% (n = 71,663) 因肢体相关住院，12.8% (n = 48,875) 因心血管原因住院，38.9% (n = 148,457) 因任何住院住院。在研究期间，肢体相关、心血管和全因住院率减少，而门诊血管内血运重建率增加。男性、黑人种族、医疗保险和医疗补助保险、糖尿病、肾功能不全、心力衰竭、吸烟、基线严重或急性肢体缺血、外科血运重建和非心脏病操作员专业与男性住院风险增加显着相关。结论在当代实践中，外周血运重建后 1 年内，十分之一的患者因 MALE 住院，并且与患者和手术因素相关。这些数据可以为改善术后结果和肢体相关临床试验设计的努力提供信息。 (C) 2018 年，美国心脏病学会基金会。
BACKGROUND Revascularization is important for symptom treatment and limb salvage in peripheral artery disease, yet little data exist on the incidence of post-procedure major adverse limb events (MALE) and longer-term outcomes.OBJECTIVES This study sought to characterize hospitalizations and outpatient endovascular revascularizations after peripheral artery revascularization, assess temporal trends for outcomes, and identify factors associated with subsequent MALE hospitalization.METHODS Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2014, in the Premier Healthcare Database were examined for the primary outcome of 1-year MALE hospitalization. Secondary outcomes included 1-year outpatient endovascular revascularization and limb-related, cardiovascular, and all-cause inpatient hospitalizations. Multivariable logistic regression was used to identify factors associated with 1-year MALE hospitalization.RESULTS Among 381,415 revascularized patients, within 1 year post-index revascularization, 10.3% (n = 10,182) had a hospitalization for MALE, 11.0% (n = 42,056) had an outpatient endovascular revascularization, 18.8% (n = 71,663) had a limb-related hospitalization, 12.8% (n = 48,875) had a cardiovascular hospitalization, and 38.9% (n = 148,457) had any inpatient hospitalization. Over the study period, limb-related, cardiovascular, and all-cause hospitalizations decreased, whereas rates of outpatient endovascular revascularizations increased. Male sex, black race, Medicare and Medicaid insurance, diabetes, renal insufficiency, heart failure, smoking, baseline critical or acute limb ischemia, surgical revascularization, and noncardiology operator specialty were significantly associated with increased risk of MALE hospitalization.CONCLUSIONS In contemporary practice, hospitalization for MALE occurs in 1 in 10 patients within 1 year after peripheral revascularization and is associated with patient and procedural factors. These data may inform efforts to improve post-procedure outcomes and limb-related clinical trial design. (C) 2018 by the American College of Cardiology Foundation.