Safley David M, House John A, Laster Steven B, Daniel William C, Spertus John A, Marso Steven P
Mid America Heart Institute, St Luke's Hospital, Kansas City, MO 64111, USA.
Circulation. 2007 Feb 6;115(5):569-75. doi: 10.1161/CIRCULATIONAHA.106.643346. Epub 2007 Jan 22.
Patients with peripheral arterial disease often undergo peripheral endovascular revascularization (PER) to alleviate symptoms. Despite the growth of PER, little information exists quantifying the health status benefits after the procedure.
From February 2001 to August 2004, 477 consecutive patients underwent PER for symptomatic peripheral arterial disease. Of these, 300 consented to participate in a longitudinal follow-up study of their health status. Health status was quantified with the disease-specific Peripheral Artery Questionnaire and the generic Short Form-12 and the EuroQol 5 Dimensions (EQ5D)questionnaire. Scores range from 0 to 100; higher scores represent fewer symptoms and better health status. The average age of the cohort was 68+/-11 years (mean+/-SD); 186 (62%) were male, 288 (96%) were white, and 118 (39%) were diabetic. Clinical follow-up was attained in 99% of patients; health status assessments were made in 86%. Mean Peripheral Artery Questionnaire summary scores improved significantly after revascularization from 31+/-19 to 62+/-27 at 1 year (P<0.0001). Generic health status scores also improved significantly (P<0.001 for all). Despite a technically successful procedure in 98% of patients, 21% of patients did not achieve the minimal clinically important improvement of an 8-point change in Peripheral Artery Questionnaire Summary score after PER (35+/-19 at baseline versus 31+/-16 at 1 year; P=0.09).
For most patients, significant and sustained improvements in symptoms, functioning, and quality of life occur after PER. Identifying and counseling patients less likely to benefit from PER is an important future research direction.
外周动脉疾病患者常接受外周血管腔内血管重建术(PER)以缓解症状。尽管PER有所发展,但关于该手术后健康状况改善情况的量化信息却很少。
2001年2月至2004年8月,477例因症状性外周动脉疾病连续接受PER的患者中,300例同意参与其健康状况的纵向随访研究。采用疾病特异性外周动脉问卷、通用的简明健康调查简表12(Short Form-12)和欧洲五维健康量表(EQ5D)问卷对健康状况进行量化。评分范围为0至100分;分数越高表示症状越少,健康状况越好。该队列的平均年龄为68±11岁(均值±标准差);186例(62%)为男性,288例(96%)为白人,118例(39%)患有糖尿病。99%的患者获得了临床随访;86%的患者进行了健康状况评估。血管重建术后1年,外周动脉问卷综合评分均值从31±19显著提高至62±27(P<0.0001)。通用健康状况评分也显著提高(均P<0.001)。尽管98%的患者手术技术成功,但21%的患者在PER后外周动脉问卷综合评分未实现至少8分变化的最小临床重要改善(基线时为35±19,1年时为31±16;P=0.09)。
对于大多数患者,PER后症状、功能和生活质量会有显著且持续的改善。识别并为不太可能从PER中获益的患者提供咨询是未来重要的研究方向。