Wickström J-E, Laivuori M, Aro E, Sund R T, Hautero O, Venermo M, Jalkanen J, Hakovirta H
Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.
Department of Vascular Surgery, University Hospital of Helsinki, Helsinki, Finland.
Eur J Vasc Endovasc Surg. 2017 May;53(5):696-703. doi: 10.1016/j.ejvs.2017.02.012. Epub 2017 Mar 11.
OBJECTIVE/BACKGROUND: Peripheral haemodynamic parameters are used to assess the presence and severity of peripheral artery disease (PAD). The prognostic value of ankle brachial index (ABI) has been thoroughly delineated. Nonetheless, the relative usefulness of ankle pressure (AP), ABI, toe pressure (TP), and toe brachial index (TBI) in assessing patient outcome has not been investigated in a concurrent study setting. This study aimed to resolve the association of all four non-invasive haemodynamic parameters in clinically symptomatic patients with PAD with cardiovascular mortality, overall mortality, and amputation free survival (AFS).
In total, 732 symptomatic patients with PAD admitted to the Department of Vascular Surgery for conventional angiography at Turku University Hospital, Turku, Finland, between January 2009 and August 2011 were reviewed retrospectively. Demographic factors, cardiovascular mortality, all-cause mortality, and above foot level amputations were obtained and assessed in relation to AP, ABI, TP, and TBI by means of Kaplan-Meier life tables and a multivariate Cox regression model.
The haemodynamic parameter that was associated with poor 36 month general outcome was TP < 30 mmHg. Univariate Cox regression analysis of stratified values showed that TP and TBI associated significantly with mortality. In multivariate analysis both TP and TBI were associated with a significant risk of death. For TP < 30 mmHg and TBI < 0.25 the risk of cardiovascular mortality was hazard ratio [HR] 2.84, 95% confidence interval [CI] 1.75-4.61 [p<.001]; HR 3.68, 95% CI 1.48-9.19 [p=.050], respectively; all-cause mortality (HR 2.05, 95% CI 1.44-2.92 [p<.001]; HR 2.53, 95% CI 1.35-4.74 [p=.040], respectively); and amputation or death (HR 2.13, 95% CI 1.52-2.98 [p<.001]; HR 2.46, 95% CI 1.38-4.40 [p=.050], respectively)...
Among non-invasive haemodynamic measurements and pressure indices both TP and TBI appear to be associated with cardiovascular and overall mortality and AFS for patients with PAD presenting symptoms of the disease.
目的/背景：外周血流动力学参数用于评估外周动脉疾病（PAD）的存在及严重程度。踝臂指数（ABI）的预后价值已得到充分阐明。然而，在同时进行的研究中，尚未对外踝压力（AP）、ABI、趾压（TP）和趾臂指数（TBI）在评估患者预后方面的相对效用进行研究。本研究旨在确定PAD有临床症状的患者中，这四项非侵入性血流动力学参数与心血管死亡率、全因死亡率和无截肢生存率（AFS）之间的关联。
回顾性分析了2009年1月至2011年8月期间，芬兰图尔库大学医院血管外科收治的732例有症状的PAD患者，这些患者因常规血管造影入院。通过Kaplan-Meier生存表和多变量Cox回归模型，获取并评估了人口统计学因素、心血管死亡率、全因死亡率以及足部以上截肢情况与AP、ABI、TP和TBI的关系。
与36个月总体预后不良相关的血流动力学参数是TP<30mmHg。分层值的单变量Cox回归分析表明，TP和TBI与死亡率显著相关。多变量分析中，TP和TBI均与显著的死亡风险相关。对于TP<30mmHg和TBI<0.25，心血管死亡率的风险比[HR]分别为2.84，95%置信区间[CI]为1.75 - 4.61 [p<0.001]；HR为3.68，95%CI为1.48 - 9.19 [p = 0.050]；全因死亡率（HR分别为2.05，95%CI为1.44 - 2.92 [p<0.001]；HR为2.53，95%CI为1.35 - 4.74 [p = 0.040]）；截肢或死亡（HR分别为2.13，95%CI为1.52 - 2.98 [p<0.001]；HR为2.46，95%CI为1.38 - 4.40 [p = 0.050]）……
在非侵入性血流动力学测量和压力指数中，对于有疾病症状的PAD患者，TP和TBI似乎均与心血管和全因死亡率以及AFS相关。
