Manfredini Fabio, Lamberti Nicola, Guerzoni Franco, Napoli Nicola, Gasbarro Vincenzo, Zamboni Paolo, Mascoli Francesco, Manfredini Roberto, Basaglia Nino, Rodríguez-Borrego María Aurora, López-Soto Pablo Jesús
Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, 44121 Ferrara, Italy.
Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, 44121 Ferrara, Italy.
J Clin Med. 2019 Feb 7;8(2):210. doi: 10.3390/jcm8020210.
The study retrospectively evaluated the association between rehabilitative outcomes and risk of peripheral revascularizations in elderly peripheral artery disease (PAD) patients with claudication. Eight-hundred thirty-five patients were enrolled. Ankle-brachial index (ABI) and maximal walking speed (S) were measured at baseline and at discharge from a structured home-based rehabilitation program. For the analysis, patients were divided according to a baseline ABI value (severe: ≤0.5; moderate: ≥0.5) and according to hemodynamic or functional rehabilitative response (responder: ABI ≥0.10 and/or S >0.5 km/h). Three-year outcomes were collected from the regional registry. According to the inclusion criteria (age 60⁻80, ABI <0.80; program completion) 457 patients, 146 severe and 311 moderate, were studied. The whole population showed significant functional and hemodynamic improvements at discharge, with 56 revascularizations and 69 deaths at follow-up. Compared to the moderate group, the severe group showed a higher rate of revascularizations (17% vs. 10%, < 0.001) and deaths (29% and 8%, respectively; < 0.001). However, patients with severe PAD who were ABI responders after rehabilitation showed less revascularizations than non-responders (13% vs. 21%; hazard ratio (HR): 0.52) and were not different from patients with moderate disease (9%). Superimposable rates were observed for S responders (13% vs. 21%; HR: 0.55; moderate 10%). In conclusion, elderly patients with severe PAD empowered by better rehabilitation outcomes showed lower rates of peripheral revascularizations and deaths that were comparable to patients with moderate PAD.
该研究回顾性评估了老年外周动脉疾病（PAD）伴间歇性跛行患者的康复结局与外周血管重建风险之间的关联。共纳入835例患者。在基线时以及从基于家庭的结构化康复计划出院时，测量踝肱指数（ABI）和最大步行速度（S）。为进行分析，根据基线ABI值（重度：≤0.5；中度：≥0.5）以及血流动力学或功能康复反应（有反应者：ABI≥0.10和/或S>0.5 km/h）对患者进行分组。从区域登记处收集三年结局数据。根据纳入标准（年龄60 - 80岁，ABI<0.80；完成计划），对457例患者进行了研究，其中重度患者146例，中度患者311例。总体人群在出院时显示出显著的功能和血流动力学改善，随访期间有56例血管重建和69例死亡。与中度组相比，重度组的血管重建率更高（分别为17%和10%，<0.001），死亡率也更高（分别为29%和8%，<0.001）。然而，康复后ABI有反应的重度PAD患者的血管重建率低于无反应者（13%对21%；风险比（HR）：0.52），且与中度疾病患者无差异（9%）。S有反应者的血管重建率相似（13%对21%；HR：0.55；中度为10%）。总之，康复结局较好的老年重度PAD患者的外周血管重建率和死亡率较低，与中度PAD患者相当。
