Mao Chun-Tai, Tsai Ming-Lung, Wang Chao-Yung, Wen Ming-Shien, Hsieh I-Chang, Hung Ming-Jui, Wang Chao-Hung, Chen Chun-Chi, Chen Tien-Hsing
Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
PLoS One. 2014 Oct 29;9(10):e111130. doi: 10.1371/journal.pone.0111130. eCollection 2014.
Little is known about long-term outcomes among patients who receive percutaneous angioplasty (PTA) for peripheral artery disease (PAD) then undergo below-knee or above-knee amputations. We sought to determine clinical outcomes associated with below-knee or above-knee amputation, along with possible explanatory factors and treatment strategies.
Using data from Taiwan's National Health Insurance Research Database from 1997 to 2010, 7,568 adult patients were divided into three groups: lower extremity preserved (LE), below-knee amputation (BK) and above-knee amputation (AK). We assessed outcomes including major adverse cardiovascular events (MACE) and associated risk factors.
Overall MACE was significantly higher in the AK group compared to the LE and BK groups, over a mean follow-up of 2.45 years (hazard ratio [HR]: 1.81; 95% confidence interval [CI]: 1.50-2.18 for AK vs. LE; HR: 1.67; 95% CI: 1.36-2.06 for AK vs. BK). However MACE were similar for the BK and LE groups (HR: 1.08; 95% CI: 0.98-1.20). Overall mortality was highest in the AK group (HR: 1.65, 95% CI: 1.34-2.04 for AK vs. BK). As for patient characteristics, atrial fibrillation was more prevalent in the AK group than in the BK group (17% vs. 7%). Independent risk factors associated with death after above- or below-knee amputation included advanced age, heart failure, dialysis, male gender and high patient volume.
The MACE rate was highest in the AK group, whereas the LE and BK groups were similar in this regard. Furthermore, overall mortality increased with larger area of amputation.
对于接受经皮血管成形术（PTA）治疗外周动脉疾病（PAD）后又进行膝下或膝上截肢的患者的长期预后了解甚少。我们试图确定与膝下或膝上截肢相关的临床结局，以及可能的解释因素和治疗策略。
利用台湾全民健康保险研究数据库1997年至2010年的数据，将7568例成年患者分为三组：下肢保留组（LE）、膝下截肢组（BK）和膝上截肢组（AK）。我们评估了包括主要不良心血管事件（MACE）及相关危险因素在内的结局。
在平均2.45年的随访期内，AK组的总体MACE显著高于LE组和BK组（风险比[HR]：AK与LE相比为1.81；95%置信区间[CI]：1.50 - 2.18；AK与BK相比HR：1.67；95% CI：1.36 - 2.06）。然而，BK组和LE组的MACE相似（HR：1.08；95% CI：0.98 - 1.20）。总体死亡率在AK组最高（AK与BK相比HR：1.65，95% CI：1.34 - 2.04）。至于患者特征，房颤在AK组比BK组更普遍（17%对7%）。与膝上或膝下截肢后死亡相关的独立危险因素包括高龄、心力衰竭、透析、男性性别和高患者数量。
AK组的MACE发生率最高，而LE组和BK组在这方面相似。此外，总体死亡率随着截肢面积的增大而增加。
