Division of Cardiology, Department of Medicine, Duke University Health System, Durham, North Carolina, USA.
Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina, USA.
Clin Cardiol. 2020 Nov;43(11):1308-1316. doi: 10.1002/clc.23444. Epub 2020 Aug 11.
Patients with chronic kidney disease (CKD) have worsened clinical outcomes following percutaneous coronary intervention; however, limited evidence exists in patients undergoing peripheral vascular intervention (PVI).
We aimed to assess the effect of CKD on outcomes following PVI for symptomatic peripheral artery disease.
Using patients from the LIBERTY 360 study, we compared the rates of 30 day and 1 year major adverse vascular events (MAVE), a composite of all-cause mortality, major amputation, and target vessel/lesion revascularization, between patients with and without CKD (estimated glomular filtration rate less than 60) following PVI. Multivariable adjustment was performed to assess for independent association between CKD and outcomes.
Among 1189 patients enrolled, 378 patients (31.8%) had CKD. At 1 year, patients with CKD had higher rates of MAVE (34.6% vs 25.6%), all-cause mortality (11.9% vs 5.5%), and major amputation (5.9% vs 2.6%) when compared with patients without CKD (all P < .05). After adjustment, patients with CKD had higher risks of 1-year MAVE (HR 1.30, 95% CI 1.04-1.64; P = .023) and all-cause mortality (HR 1.88, 95% CI 1.22-2.91; P = .005) when compared with patients without CKD. There was no statistically significant difference in risk of major amputations (HR 1.70, 95% CI 0.91-3.17; P = .094).
Despite high procedural success and low amputation rates, patients with CKD remain at greater risk for MAVE and all-cause mortality after PVI. Further research is needed to determine treatment strategies to mitigate substantial mortality risk in this vulnerable population.
患有慢性肾病（CKD）的患者经皮冠状动脉介入治疗后临床结局恶化，但接受外周血管介入（PVI）治疗的患者相关证据有限。
我们旨在评估 CKD 对外周动脉疾病症状性 PVI 后结局的影响。
使用 LIBERTY 360 研究中的患者，我们比较了 PVI 后 CKD（估算肾小球滤过率＜60）患者与无 CKD 患者 30 天和 1 年主要不良血管事件（MAVE）的发生率，MAVE 是全因死亡率、主要截肢和靶血管/病变血运重建的综合指标。进行多变量调整以评估 CKD 与结局之间的独立关联。
在纳入的 1189 名患者中，378 名（31.8%）患者患有 CKD。在 1 年时，与无 CKD 的患者相比，CKD 患者的 MAVE（34.6%比 25.6%）、全因死亡率（11.9%比 5.5%）和主要截肢（5.9%比 2.6%）发生率更高（均 P<0.05）。调整后，与无 CKD 的患者相比，CKD 患者 1 年时 MAVE（HR 1.30，95%CI 1.04-1.64；P=0.023）和全因死亡率（HR 1.88，95%CI 1.22-2.91；P=0.005）的风险更高。但在截肢风险方面无统计学显著差异（HR 1.70，95%CI 0.91-3.17；P=0.094）。
尽管手术成功率高且截肢率低，但 CKD 患者 PVI 后仍有更高的 MAVE 和全因死亡率风险。需要进一步研究以确定治疗策略，以减轻这一脆弱人群的高死亡率风险。
