Cardiovascular Center, Kansai Rosai Hospital.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine.
J Atheroscler Thromb. 2021 Nov 1;28(11):1145-1152. doi: 10.5551/jat.60053. Epub 2020 Nov 20.
The aim of the current study was to describe the clinical profile, frequency of in-hospital complications, and predictors of adverse events in patients undergoing endovascular therapy (EVT) for acute limb ischemia (ALI), and to compare them with those of patients undergoing EVT for chronic symptomatic peripheral artery disease (PAD).
The current study compared 2,398 cases of EVT for ALI with 74,171 cases of EVT for chronic symptomatic PAD performed between January 2015 and December 2018 in Japan. We first compared the clinical profiles of ALI patients with those of PAD patients. We then evaluated the proportion of in-hospital complications and investigated their risk factors in the ALI patients. The association of clinical characteristics with the risk of in-hospital complications was analyzed via logistic regression modeling.
Patients with ALI were older and had a higher prevalence of female sex, impaired mobility, and history of cerebrovascular disease, but a lower prevalence of cardiovascular risk factors and history of coronary artery disease. The proportion of in-hospital EVT-related complications in ALI was 6.1% and was significantly higher compared with those in chronic symptomatic PAD patients (2.0%, P＜0.001). Bedridden status (adjusted odds ratio [aOR], 1.74 [1.14 to 2.66]; P=0.010), history of coronary artery disease (aOR, 1.80 [1.21 to 2.68]; P=0.004), and a suprapopliteal lesion (aOR, 1.70 [1.05 to 2.74]; P=0.030) were identified as independent risk factors for in-hospital complications.
The current study demonstrated that ALI patients with significant comorbidities show a higher proportion of in-hospital complications after EVT.
本研究旨在描述急性肢体缺血（ALI）患者接受血管内治疗（EVT）的临床特征、住院并发症发生率和不良事件预测因素，并与慢性症状性外周动脉疾病（PAD）患者接受 EVT 的情况进行比较。
本研究比较了 2015 年 1 月至 2018 年 12 月在日本接受 EVT 治疗的 2398 例 ALI 患者和 74171 例慢性症状性 PAD 患者。首先，我们比较了 ALI 患者和 PAD 患者的临床特征。然后，我们评估了 ALI 患者住院并发症的比例，并对其危险因素进行了调查。通过逻辑回归模型分析临床特征与住院并发症风险的关系。
ALI 患者年龄较大，女性、活动能力受损和脑血管疾病史的比例较高，而心血管危险因素和冠心病史的比例较低。ALI 患者住院期间 EVT 相关并发症的比例为 6.1%，明显高于慢性症状性 PAD 患者（2.0%，P＜0.001）。卧床状态（调整后优势比 [aOR]，1.74 [1.14 至 2.66]；P=0.010）、冠心病史（aOR，1.80 [1.21 至 2.68]；P=0.004）和腘下病变（aOR，1.70 [1.05 至 2.74]；P=0.030）是住院并发症的独立危险因素。
本研究表明，合并症较多的 ALI 患者在接受 EVT 后住院并发症的比例更高。
