Lee Michael S, Rha Seung-Woon, Han Seung Kyu, Choi Byoung Geol, Choi Se Yeon, Park Yoonjee, Akkala Raghu, Li Hu, Im Sung Il, Kim Ji Bak, Lee Sunki, Na Jin Oh, Choi Cheol Ung, Lim Hong Euy, Kim Jin Won, Kim Eung Ju, Park Chang Gyu, Seo Hong Seog, Oh Dong Joo
Cardiovascular Center, Korea University Guro Hospital, 80, Gurodong, Guro-gu, Seoul, 152-703, Korea.
J Invasive Cardiol. 2015 Apr;27(4):213-7.
Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA).
Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis.
Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P=.45), myocardial infarction (1.1% vs 0%; P=.31), and PCI (4.7% vs 1.1%; P=.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P=.86), target lesion revascularization (13.7% vs 14.1%; P=.94), and amputation (19.1% vs 16.4%; P=.60).
A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.
严重肢体缺血（CLI）与心血管缺血事件的高风险相关。我们评估了在接受经皮腔内血管成形术（PTA）的CLI患者中，进行常规冠状动脉造影及随后根据临床指征进行冠状动脉血运重建的策略。
在总共286例连续接受PTA治疗的CLI患者中，纳入了252例在PTA之前或之后接受冠状动脉造影的患者。冠状动脉疾病（CAD）定义为血管造影狭窄≥50%，严重CAD定义为狭窄≥70%。
在252例接受冠状动脉造影的CLI患者中，共有167例（66.3%）患有CAD，85例（33.7%）没有CAD。CAD组患者年龄更大，糖尿病和脑血管疾病的患病率更高，平均射血分数更低。在CAD组中，145例严重CAD患者中有114例（78.6%）接受了经皮冠状动脉介入治疗（PCI）。1年时，CAD组和非CAD组在死亡率（7.1%对4.7%；P = 0.45）、心肌梗死（1.1%对0%；P = 0.31）和PCI（4.7%对1.1%；P = 0.31）方面无统计学显著差异。在调整基线混杂因素后，这些结果相似。1年时，CAD组和非CAD组的重复PTA率（16.7%对17.6%；P = 0.86）、靶病变血运重建率（13.7%对14.1%；P = 0.94）和截肢率（19.1%对16.4%；P = 0.60）相似。
对于这些有严重CAD高风险的患者，常规冠状动脉造影和冠状动脉血运重建策略可能是一种合理的治疗选择。需要进行一项随机试验来确定这是否是CLI患者的首选策略。
