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Outcomes With Major Adverse Limb Events After Peripheral Revascularization
Study Questions:
What are the outcomes after peripheral revascularization and relationships between post-procedure major adverse limb event (MALE) hospitalization and subsequent events?
Methods:
The investigators examined patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2015, in the Premier Healthcare Database for the co-primary outcomes of interest, composite myocardial infarction (MI) or stroke and composite major amputation or peripheral revascularization. Multivariable adjusted Cox proportional hazards models with post-procedure MALE hospitalization included as a time-dependent covariate were developed to estimate hazard ratios for outcomes.
Results:
Among 393,017 revascularized patients followed for a median of 2.7 years (interquartile range, 1.3-4.4 years), the cumulative incidence of MI or stroke was 9.8% and that of major amputation or peripheral revascularization was 41.9%. A total of 50,750 patients (12.9%) had ≥1 post-procedure MALE hospitalization. In time-dependent covariate adjusted models, post-procedure MALE hospitalization was associated with greater risk of subsequent MI or stroke (hazard ratio, 1.34; 95% confidence interval, 1.28-1.40) and major amputation or peripheral revascularization (hazard ratio, 8.13; 95% confidence interval, 7.96-8.29). After peripheral revascularization with or without postprocedure MALE hospitalization, risk of limb events increased rapidly post-procedure and more slowly after the first year, whereas cardiac risk increased steadily during follow-up.
Conclusions:
The authors concluded that revascularized peripheral artery disease patients face earlier limb and later cardiovascular ischemic risk that is heightened among patients with post-procedure MALE hospitalization.
Perspective:
This large, observational study reports that patients receiving peripheral artery revascularization face long-term risk of cardiovascular and limb ischemic events with the post-procedure risk of limb events increasing most quickly within the first year, with more than 1 in 10 patients hospitalized for MALE, typically within the first-year post-index encounter. Furthermore, post-procedure MALE hospitalization was associated with 1.34-fold increased risk of MI or stroke and 8.13-fold increased risk of subsequent major amputation or peripheral revascularization. These findings highlight opportunities for targeting future efforts to improve outcomes in revascularized PAD patients, including optimization of procedural techniques and periprocedural care, as well as aggressive secondary prevention therapies during long-term follow-up.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Interventions and Vascular Medicine
Keywords: Amputation, Hospitalization, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Outcome Assessment, Health Care, Peripheral Arterial Disease, Risk, Secondary Prevention, Stroke, Vascular Diseases
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