Kanda Daisuke, Ikeda Yoshiyuki, Sonoda Takeshi, Tokushige Akihiro, Kosedo Ippei, Yoshino Satoshi, Takumi Takuro, Ohishi Mitsuru
Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan.
Circ Rep. 2019 Dec 28;2(2):121-127. doi: 10.1253/circrep.CR-19-0105.
Critical limb ischemia (CLI) patients have high risk for major adverse cerebrovascular and cardiovascular events. This study investigated the risk factors of cerebrovascular or cardiovascular death in CLI patients with concomitant coronary artery disease (CAD). The association between baseline characteristics and cerebrovascular or cardiovascular death ≤2 years after revascularization for CLI was investigated in 137 CLI patients who previously underwent successful revascularization for CAD before treatment for CLI. Twenty-three patients (17%) died. Geriatric nutritional risk index (GNRI) in the deceased group (DG) was significantly lower than in the surviving group (SG). On Cox proportional hazard multivariate analysis, hemodialysis (HD) and malnutrition (defined as GNRI <92) were significantly associated with cerebrovascular or cardiovascular death. Also, on Kaplan-Meier analysis, survival rate was significantly lower in CLI patients with either malnutrition or HD compared with patients without either malnutrition or HD, respectively. Furthermore, clopidogrel was less used in the DG than in the SG. The use of clopidogrel was associated with cerebrovascular or cardiovascular death. Especially, non-use of clopidogrel in the malnutrition group further increased the correlation with cerebrovascular or cardiovascular death. Malnutrition is a crucial risk factor for cerebrovascular and cardiovascular death in CLI patients with CAD. Nutritional status intervention and use of clopidogrel may be an important strategy for CLI.
严重肢体缺血（CLI）患者发生重大脑血管和心血管不良事件的风险很高。本研究调查了合并冠状动脉疾病（CAD）的CLI患者发生脑血管或心血管死亡的危险因素。在137例CLI患者中，研究了基线特征与CLI血运重建后≤2年脑血管或心血管死亡之间的关联，这些患者在接受CLI治疗之前曾因CAD成功进行过血运重建。23例患者（17%）死亡。死亡组（DG）的老年营养风险指数（GNRI）显著低于存活组（SG）。在Cox比例风险多因素分析中，血液透析（HD）和营养不良（定义为GNRI<92）与脑血管或心血管死亡显著相关。此外，在Kaplan-Meier分析中，合并营养不良或HD的CLI患者的生存率分别显著低于未合并营养不良或HD的患者。此外DG组使用氯吡格雷的比例低于SG组。氯吡格雷的使用与脑血管或心血管死亡相关。特别是，营养不良组未使用氯吡格雷进一步增加了与脑血管或心血管死亡的相关性。营养不良是合并CAD的CLI患者发生脑血管和心血管死亡的关键危险因素。营养状况干预和氯吡格雷的使用可能是CLI的重要治疗策略。
