Linehan Victoria, Doyle Maria, Barrett Brendan, Gullipalli Ravindra
Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
Vasc Endovascular Surg. 2020 Jul;54(5):400-405. doi: 10.1177/1538574420920994. Epub 2020 Apr 22.
Paclitaxel-coated devices have been increasingly used in endovascular treatment of femoropopliteal disease as they limit recurrence of lesions and improve patient outcomes. However, a recent meta-analysis reported that these devices increase mortality risk at 2 years post-intervention but did not account for confounding variables. Therefore, our goal was to evaluate mortality after paclitaxel treatment of femoropopliteal disease using patient-level data.
We performed a retrospective review of all patients who received endovascular treatment for femoropopliteal lesions at our center between December 2009 and July 2017. There were 388 patients in the paclitaxel group and 314 control patients.
Survival analysis with hazard ratios showed no difference between mortality in the paclitaxel and control groups. Age, renal insufficiency, and chronic limb-threatening ischemia were significant predictors of mortality. We also used logistic regression to evaluate mortality at 1, 2, and 5 years post-intervention and found no difference between the paclitaxel and control groups at any time point, while age, renal insufficiency, and chronic limb-threatening ischemia at the time of intervention were all associated with the risk of death. Finally, we tallied the causes of death in our cohort and found no difference in the distribution of causes between groups.
Our single-center, retrospective study provides no evidence of increased risk of death with paclitaxel treatment in femoropopliteal disease. Contrastingly, age, renal insufficiency, and chronic limb-threatening ischemia were the most important factors contributing to mortality and therefore should be included as potential confounders in future studies assessing mortality in femoropopliteal disease.
紫杉醇涂层器械在股腘动脉疾病的血管内治疗中使用越来越多，因为它们可限制病变复发并改善患者预后。然而，最近一项荟萃分析报告称，这些器械会增加干预后2年的死亡风险，但未考虑混杂变量。因此，我们的目标是使用患者层面的数据评估紫杉醇治疗股腘动脉疾病后的死亡率。
我们对2009年12月至2017年7月期间在本中心接受股腘动脉病变血管内治疗的所有患者进行了回顾性研究。紫杉醇组有388例患者，对照组有314例患者。
采用风险比的生存分析显示，紫杉醇组和对照组的死亡率无差异。年龄、肾功能不全和慢性肢体威胁性缺血是死亡率的重要预测因素。我们还使用逻辑回归评估干预后1年、2年和5年的死亡率，发现在任何时间点紫杉醇组和对照组之间均无差异，而干预时的年龄、肾功能不全和慢性肢体威胁性缺血均与死亡风险相关。最后，我们统计了队列中的死亡原因，发现两组之间死因分布无差异。
我们的单中心回顾性研究没有提供证据表明紫杉醇治疗股腘动脉疾病会增加死亡风险。相反，年龄、肾功能不全和慢性肢体威胁性缺血是导致死亡的最重要因素，因此在未来评估股腘动脉疾病死亡率的研究中应将其作为潜在的混杂因素纳入。
