Okuno Shota, Iida Osamu, Shiraki Tatsuya, Fujita Masashi, Masuda Masaharu, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Kanda Takashi, Takahara Mitsuyoshi, Uematsu Masaaki
Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
J Endovasc Ther. 2016 Oct;23(5):731-7. doi: 10.1177/1526602816656612. Epub 2016 Jul 1.
To investigate whether the severity of lesion calcification assessed by the novel peripheral artery calcification scoring system (PACSS) was associated with clinical outcomes after endovascular therapy (EVT) for superficial femoral artery (SFA) lesions.
A retrospective analysis was conducted of 394 consecutive patients (mean age 72±8 years; 290 men) with intermittent claudication [223 (57%) with diabetes, 81 (21%) on hemodialysis] who underwent successful EVT for de novo SFA lesions [length 152.1±95.7 mm; 199 (50%) TransAtlantic Inter-Society Consensus II class C/D] between January 2010 and December 2013. The patients were retrospectively categorized using the PACSS classification (grades 0-4: no visible calcification of the target lesion, unilateral wall calcification <5 cm, unilateral calcification ≥5 cm, bilateral wall calcification <5 cm, and bilateral calcification ≥5 cm, respectively). The main outcome was primary patency, while the secondary outcome measures were mortality and major adverse limb events [MALE: any intervention (repeat EVT or surgical revision) or major (above ankle) amputation]. Cox proportional hazards analysis was used to explore whether the PACSS classification was an independent predictor of clinical outcomes. Results are presented as the hazard ratio (HR) and 95% confidence interval (CI).
The distribution of PACSS grades was 0 in 54%, grade 1 in 16%, grade 2 in 12%, grade 3 in 9%, and grade 4 in 9%. The 2-year primary patency rates in these grades, respectively, were 70.0%, 66.6%, 72.1%, 55.6%, and 36.3% (p<0.001). After multivariate analysis, PACSS grade 4 (HR 2.74, 95% CI 1.56 to 4.83, p<0.001), diabetes (HR 1.52, 95% CI 1.06 to 2.20, p=0.022), lesion length (HR 1.04, 95% CI 1.01 to 1.07, p=0.006), and vessel diameter (HR 0.80, 85% CI 0.65 to 0.98, p=0.038) were associated with loss of primary patency. PACSS grade 4 was also associated with MALE and mortality (p=0.048 and 0.011, respectively). Bare metal stent use (HR 0.47, 95% CI 0.30 to 0.73, p<0.001) was positively associated with primary patency.
PACSS grade 4 calcification was independently associated with clinical outcomes after EVT for de novo SFA lesions.
探讨采用新型外周动脉钙化评分系统（PACSS）评估的病变钙化严重程度是否与股浅动脉（SFA）病变血管内治疗（EVT）后的临床结局相关。
对2010年1月至2013年12月期间连续394例因间歇性跛行接受成功的新发SFA病变EVT治疗的患者（平均年龄72±8岁；男性290例）进行回顾性分析[223例（57%）患有糖尿病，81例（21%）接受血液透析]。这些患者的病变长度为152.1±95.7mm；199例（50%）为跨大西洋两岸血管外科学会共识II级C/D病变。采用PACSS分类对患者进行回顾性分组（0-4级：目标病变无可见钙化、单侧管壁钙化<5cm、单侧钙化≥5cm、双侧管壁钙化<5cm、双侧钙化≥5cm）。主要结局为原发性通畅率，次要结局指标为死亡率和主要肢体不良事件[MALE：任何干预措施（重复EVT或手术翻修）或大截肢（踝关节以上）]。采用Cox比例风险分析探讨PACSS分类是否为临床结局的独立预测因素。结果以风险比（HR）和95%置信区间（CI）表示。
PACSS分级分布为：0级占54%，1级占16%，2级占12%，3级占9%，4级占9%。这些分级的2年原发性通畅率分别为70.0%、66.6%、72.1%、55.6%和36.3%（p<0.001）。多因素分析后，PACSS 4级（HR 2.74，95%CI 1.56至4.83，p<0.001）、糖尿病（HR 1.52，95%CI 1.06至2.20，p=0.022）、病变长度（HR 1.04，95%CI 1.01至1.07，p=0.006）和血管直径（HR 0.80，85%CI 0.65至0.98，p=0.038）与原发性通畅率丧失相关。PACSS 4级也与MALE和死亡率相关（分别为p=0.048和0.011）。使用裸金属支架（HR 0.47，95%CI 0.30至0.73，p<0.001）与原发性通畅率呈正相关。
PACSS 4级钙化与新发SFA病变EVT后的临床结局独立相关。
