Division of Cardiology, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy.
Int J Cardiol. 2013 Sep 10;167(6):2566-71. doi: 10.1016/j.ijcard.2012.06.055. Epub 2012 Jul 11.
Lower extremity peripheral arterial disease (LE-PAD) reduces walking capacity and is associated with an increased cardiovascular risk. Endovascular revascularization of LE-PAD improves walking performance and quality of life. In the present study, we determined whether successful lower limbs revascularization also impacts cardiovascular outcome in LE-PAD patients.
479 consecutive LE-PAD patients at stage II of Fontaine's classification, with ankle/brachial index ≤ 0.90 and one or more stenosis >50% in at least one leg artery, were enrolled in the study. According to the Trans-Atlantic Inter Society Consensus II recommendations, 264 (55.1%) underwent percutaneous lower extremity angioplasty (PTA group), while 215 (44.9%) were managed with conservative therapy (MT group). The incidence of major cardiovascular events (including cardiovascular death, myocardial infarction, ischemic stroke, coronary and carotid revascularizations) was prospectively analyzed by Kaplan-Meier curves. Crude and adjusted HRs (95% CI) of developing a cardiovascular event were calculated by Cox analysis.
No baseline differences were observed among the groups, except for a lower maximum walking distance in the PTA group. During a median follow-up of 21 months (12.0-29.0), the incidence of cardiovascular events was markedly lower in PTA compared to MT patients (6.4% vs. 16.3%; p=0.003), and patients in the MT group showed a 4.1-fold increased cardiovascular risk compared to patients in the PTA group, after adjustment for potential confounders (95% CI 1.22-13.57, p=0.023).
This study shows that successful revascularization of LE-PAD patients affected by intermittent claudication, in addition to improving functional status, reduces the occurrence of future major cardiovascular events.
下肢外周动脉疾病（LE-PAD）会降低步行能力，并与心血管风险增加相关。LE-PAD 的血管内血运重建可改善步行能力和生活质量。在本研究中，我们确定下肢血运重建的成功是否也会影响 LE-PAD 患者的心血管结局。
纳入了 479 例处于 Fontaine 分类 II 期的连续 LE-PAD 患者，踝肱指数≤0.90，至少一条腿部动脉有一处或多处狭窄>50%。根据跨大西洋内科学会共识 II 建议，264 例（55.1%）接受了经皮下肢血管成形术（PTA 组），而 215 例（44.9%）接受了保守治疗（MT 组）。通过 Kaplan-Meier 曲线前瞻性分析主要心血管事件（包括心血管死亡、心肌梗死、缺血性卒中和冠状动脉及颈动脉血运重建）的发生率。通过 Cox 分析计算发生心血管事件的粗和调整后的 HR（95%CI）。
两组患者除 PTA 组最大步行距离较低外，基线无差异。在中位数为 21 个月（12.0-29.0）的随访期间，与 MT 组患者相比，PTA 组患者的心血管事件发生率明显更低（6.4%比 16.3%；p=0.003），并且在调整了潜在混杂因素后，MT 组患者的心血管风险比 PTA 组患者高 4.1 倍（95%CI 1.22-13.57，p=0.023）。
这项研究表明，除了改善功能状态外，成功的 LE-PAD 间歇性跛行患者的血运重建还可减少未来重大心血管事件的发生。
