Clinical Outcome and Diverse Risk Factors for Different Therapeutic Target Locations of Peripheral Artery Disease
Clinical Outcome and Diverse Risk Factors for Different Therapeutic Target Locations of Peripheral Artery Disease
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DOI：
10.5551/jat.52647
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发表时间：
2020-01-01
影响因子：
4.4
通讯作者：
Komuro, Issei
中科院分区：
文献类型：
--
作者：
Ko, Toshiyuki;Higashitani, Michiaki;Komuro, Issei
目的：既往关于外周动脉疾病（PAD）的研究仅入组了动脉粥样硬化病变局限于任何一个孤立部位（髂动脉[Al]、股腘动脉[FP]和膝下[BTK]）的患者。然而，在现实世界的临床环境中，PAD的干预往往是同时进行几个不同的locations.Methods：我们进行了一项前瞻性多中心研究，其中包括2,230例PAD患者接受下肢病变的干预，在每个领域和跨不同领域。根据治疗部位的组合将患者分为7组。总生存期（OS），主要不良肢体事件（MALEs），OS和MALES.Results的危险因素进行了统计分析：调整混杂因素后，OS的归因风险是孤立的铝，FP和BTK治疗之间相似。雄性增加与给药部位数量相关。透析和严重肢体缺血是OS和MALE的常见危险因素。然而，其他因素的贡献，如药物使用的类型是不同的，根据治疗location.Conclusions：在PAD患者，OS主要是由合并症，但不是病变位置定义。背景危险因素、基础合并症和事件发生率根据PAD位置不同而不同，表明应针对不同患者人群建立分层治疗。
Aim: Previous studies on peripheral artery disease (PAD) only enrolled patients with atherosclerotic lesion limited to any one of isolated locations (aortoiliac [Al], femoropopliteal [FP], and below the knee [BTK]). However, the interventions for PAD in a real-world clinical setting are often simultaneously performed for several different locations.Methods: We conducted a prospective multicenter study that included 2,230 patients with PAD who received intervention for lower extremity lesions in each area and across different areas. Patients were divided into 7 groups according to the combination of treatment locations. Overall survival (OS), major adverse limb events (MALEs), and risk factors for OS and MALES were statistically analyzed.Results: After adjustment for confounding factors, the attributable risk for OS was similar among isolated Al, FP, and BTK treatments. MALES increased in correlation with the number of treatment locations. Dialysis and critical limb ischemia were the common risk factors for OS and MALEs. However, the contribution of other factors such as type of drug usage was different according to treatment locations.Conclusions: In patients with PAD, OS was largely defined by comorbidities but not by lesion location. The background risk factors, underlying comorbidities, and event rates were different according to PAD location, suggesting that stratified treatment should be established for different patient populations.