Rivero Mariel, Nader Nader D, Blochle Raphael, Harris Linda M, Dryjski Maciej L, Dosluoglu Hasan H
Division of Vascular Surgery, Veterans Affairs Western New York Healthcare System, Buffalo, NY; Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
Department of Anesthesiology, Veterans Affairs Western New York Healthcare System, State University of New York at Buffalo, Buffalo, NY.
J Vasc Surg. 2016 May;63(5):1318-24. doi: 10.1016/j.jvs.2015.11.052. Epub 2016 Mar 19.
African Americans (AAs) with symptomatic peripheral arterial disease (PAD) have been reported to have fewer revascularization attempts and poorer patency and limb salvage (LS) rates than Caucasians (CAUs). This study compared the outcomes between AA and CAU men with chronic limb ischemia.
All AA and CAU men who underwent treatment for symptomatic PAD between November 1, 2003, and May 31, 2012, were included. Patency rates, LS, major adverse cardiovascular and limb events, amputation-free survival, and survival were compared before and after propensity score matching and with multivariate (Cox regression) analysis.
Of the 834 men (1062 limbs), 107 were AA (137 limbs) and 727 were CAU (925 limbs). AAs were more likely to have insulin-dependent diabetes mellitus, hypertension, dialysis dependence, lower albumin levels, and critical limb ischemia (73% vs 61%; P = .006), whereas CAUs had more coronary artery disease, dyslipidemia, and chronic obstructive pulmonary disease. In patients with critical limb ischemia, primary amputation rates (10.9% vs 7.2%; P = .209) were similar between groups; however, infrapopliteal interventions were more frequent in AAs (62.6% vs 44.3%; P = .004). Perioperative morbidity and mortality rates were similar. Mean follow-up was 38.5 ± 28.9 months (range, 0-119 months). Patency rates, major adverse limb and cardiovascular events, amputation-free survival, and survival were similar in AAs and CAUs; however, the LS rate was significantly lower in AA (73% ± 6% vs 83% ± 2%; P = .048), mainly due to the difference in the endovascular-treated group (5-year LS, 69% ± 7% in AAs vs 84% ± 2% in CAUs; P = .025). All outcomes were similar in propensity score-matched cohorts. In multivariate analysis, insulin-dependent diabetes mellitus, gangrene, poor functional capacity, dialysis-dependence, and need for infrapopliteal revascularization were independently associated with limb loss, whereas race was not.
AA men with symptomatic PAD were found to have lower LS rates than CAUs. However, this was likely due to presenting with advanced ischemia or with poor prognostic factors that are independently associated with limb loss.
据报道，有症状的外周动脉疾病（PAD）的非裔美国人（AA）比白人（CAU）进行血运重建尝试的次数更少，通畅率和肢体挽救（LS）率更低。本研究比较了患有慢性肢体缺血的非裔美国男性和白人男性之间的治疗结果。
纳入2003年11月1日至2012年5月31日期间接受有症状PAD治疗的所有非裔美国男性和白人男性。在倾向评分匹配前后以及通过多变量（Cox回归）分析比较通畅率、LS、主要不良心血管和肢体事件、无截肢生存率和生存率。
在834名男性（1062条肢体）中，107名是非裔美国人（137条肢体），727名是白人（925条肢体）。非裔美国人更有可能患有胰岛素依赖型糖尿病、高血压、依赖透析、白蛋白水平较低以及严重肢体缺血（73%对61%；P = 0.006），而白人患有更多的冠状动脉疾病、血脂异常和慢性阻塞性肺疾病。在严重肢体缺血患者中，两组之间的初次截肢率相似（10.9%对7.2%；P = 0.209）；然而，非裔美国人腘动脉以下干预更频繁（62.6%对44.3%；P = 0.004）。围手术期发病率和死亡率相似。平均随访时间为38.5±28.9个月（范围，0 - 119个月）。非裔美国人和白人的通畅率、主要不良肢体和心血管事件、无截肢生存率和生存率相似；然而，非裔美国人的LS率显著更低（73%±6%对83%±2%；P = 0.048），主要是由于血管内治疗组的差异（5年LS，非裔美国人为69%±7%，白人为84%±2%；P = 0.025）。倾向评分匹配队列中的所有结果相似。在多变量分析中，胰岛素依赖型糖尿病、坏疽、功能能力差、依赖透析以及腘动脉以下血运重建的需求与肢体丢失独立相关，而种族并非如此。
发现有症状PAD的非裔美国男性的LS率低于白人男性。然而，这可能是由于出现了晚期缺血或存在与肢体丢失独立相关的不良预后因素。
