Major Adverse Events More Common After PVI in Patients With CLI, NCDR Study Shows

Patients with critical limb ischemia (CLI) undergoing peripheral vascular intervention (PVI) may be more likely to experience in-hospital major adverse cardiovascular and limb events, according to a review letter published Feb. 10 in the Journal of the American College of Cardiology.

Jennifer A. Rymer, MD, MBA, et al., used data from ACC's PVI Registry to compare in-hospital major adverse cardiovascular events (MACE) and in-hospital major adverse limb events (MALE) among patients with CLI vs. claudication undergoing PVI. MACE was defined as the composite of all-cause death, myocardial infarction, stroke or transient ischemic attack, while MALE was defined as emergency vascular surgery, all-cause amputation, other vascular complications requiring treatment or compartment syndrome. The researchers also examined the proportion of patients with CLI vs. claudication who received guideline-directed medical therapy at discharge.

Of 27,621 patients undergoing PVI, 12,558 (45.5%) had CLI and 15,063 (54.5%) had claudication. Patients with CLI were more likely to have diabetes, end-stage renal disease or a history of heart failure. Patients with CLI were more likely than those with claudication to experience both MACE (1.37% vs. 0.26%) and MALE (1.56% vs. 0.69%). At discharge, patients with CLI were less likely than those with claudication to receive guideline-directed medical therapy, including aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker, and statins.

According to the researchers, the findings show that patients with CLI are more likely to experience in-hospital MACE and MALE and demonstrate underutilization of guideline-directed medical therapy in these patients. They conclude that national quality improvement efforts around PVI are necessary to improve care for CLI patient population.

Clinical Topics: Heart Failure and Cardiomyopathies, Vascular Medicine, Acute Heart Failure

Keywords: Ischemic Attack, Transient, Quality Improvement, Stroke, Intermittent Claudication, Myocardial Infarction, Angiotensin-Converting Enzyme Inhibitors, Registries, National Cardiovascular Data Registries, PVI Registry, Heart Failure, Diabetes Mellitus, Kidney Failure, Chronic, Angiotensin Receptor Antagonists

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