Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American
E Hope Weissler1, Yongfei Wang2,3, Jordan M Gales4
1Division of Vascular and Endovascular Surgery Department of Surgery Duke University School of Medicine Durham NC.
Insights
Patients undergoing peripheral vascular intervention (PVI) for chronic limb threatening ischemia (CLTI) face high risks of major adverse cardiovascular and limb events (MACE and MALE). Associated factors include patient comorbidities and procedural details, highlighting areas for improved patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Health Outcomes Research
Background:
- Peripheral artery disease (PAD) affects numerous patients, with chronic limb threatening ischemia (CLTI) representing its most severe form.
- Peripheral vascular intervention (PVI) is a common treatment for PAD, but carries significant risks of adverse events.
Purpose of the Study:
- To characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) after PVI.
- To identify factors associated with MACE and MALE in patients with CLTI undergoing PVI.
Main Methods:
- Analysis of patients undergoing PVI from the ACC's PVI Registry linked to Medicare data.
- Primary outcomes included MACE, MALE, and readmission at 1 month and 1 year post-PVI.
- Cox proportional hazards regression identified predictors of MACE and MALE in CLTI patients.
Main Results:
- By 1 year, MACE occurred in 29.5% and MALE in 34.0% of CLTI patients, versus 8.2% MACE and 26.1% MALE in non-CLTI patients.
- Predictors of MACE in CLTI-PVI included end-stage renal disease, congestive heart failure, prior CABG, and severe lung disease.
- Predictors of MALE in CLTI-PVI included prior bypass graft treatment, profunda femoral artery treatment, end-stage renal disease, and previously treated lesion intervention.
Conclusions:
- Patients aged 65 and older undergoing PVI experience high rates of MACE and MALE.
- Both modifiable and non-modifiable patient factors, procedural characteristics, and medications are associated with adverse events after CLTI-PVI.
Background:
We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (CLTI).
Methods And Results:
Patients undergoing PVI in the American College of Cardiology's (ACC) National Cardiovascular Data Registry's PVI Registry who could be linked to Centers for Medicare and Medicaid Services data were included. The primary outcomes were MACE, MALE, and readmission within 1 month and 1 year following index CLTI-PVI or non-CLTI-PVI. Cox proportional hazards regression was used to identify factors associated with the development of the primary outcomes among patients undergoing CLTI-PVI. There were 1758 (49.7%) patients undergoing CLTI-PVI and 1779 (50.3%) undergoing non-CLTI-PVI. By 1 year, MACE occurred in 29.5% of patients with CLTI (n=519), and MALE occurred in 34.0% of patients with CLTI (n=598). By 1 year, MACE occurred in 8.2% of patients with non-CLTI (n=146), and MALE occurred in 26.1% of patients with non-CLTI (n=465). Predictors of MACE at 1 year in CLTI-PVI included end-stage renal disease on hemodialysis, congestive heart failure, prior CABG, and severe lung disease. Predictors of MALE at 1 year in CLTI-PVI included treatment of a prior bypass graft, profunda femoral artery treatment, end-stage renal disease on hemodialysis, and treatment of a previously treated lesion.
Conclusions:
Patients ≥65 years old undergoing PVI experience high rates of MACE and MALE. A range of modifiable and non-modifiable patient factors, procedural characteristics, and medications are associated with the occurrence of MACE and MALE following CLTI-PVI.
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