Analysis Group, Inc., Boston, Massachusetts.
Janssen Scientific Affairs, LLC, Titusville, New Jersey.
Ann Vasc Surg. 2021 Aug;75:217-226. doi: 10.1016/j.avsg.2021.02.025. Epub 2021 Apr 2.
Patients with peripheral artery disease (PAD) treated with lower extremity revascularization are at increased risk of major atherothrombotic vascular events (acute limb ischemia (ALI), major non-traumatic lower-limb amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular (CV)-related death). This study assessed the incidence of major atherothrombotic vascular events, venous thromboembolism (VTE) events and rates of subsequent lower extremity revascularizations in the real-world among patients with PAD after revascularization.
Patients aged ≥50 years with PAD who underwent peripheral revascularization were identified from Optum Clinformatics Data Mart claims database (Q1/2014-Q2/2019). The first lower extremity revascularization after PAD diagnosis was defined as index date. Incidence rates of major atherothrombotic vascular events (i.e., composite of ALI, major non-traumatic lower-limb amputation, MI, ischemic stroke, and CV-related death) and VTE were assessed during follow-up as the number of events divided by patient-years of observation (censored at the first event). Rates of subsequent revascularizations and VTE were estimated overall and compared between patients with major atherothrombotic vascular events and those without.
Of the 38,439 patients included, 6,675 (17.4%) had a major atherothrombotic vascular event during a median follow-up of 1.0 year. The composite major atherothrombotic vascular and VTE incidence rates were 13.81/100 patient years and 1.77/100 patient years, respectively, and 40.2% of patients experienced subsequent revascularizations. Patients with a post-revascularization major atherothrombotic vascular event had significantly higher rates of subsequent revascularizations (64.6% vs. 35.1%, standardized difference [SD] ≥10%) and VTE (4.6% vs. 2.1%, SD ≥10%) versus those without.
One-in-six PAD patients aged ≥50 years who underwent peripheral revascularization experienced a major atherothrombotic vascular event within one year, and consequently, experienced higher rates of subsequent revascularizations compared with those without a major atherothrombotic vascular event post-revascularization. These findings highlight the need to improve strategies to prevent major atherothrombotic vascular events after revascularization.
下肢血运重建治疗的外周动脉疾病（PAD）患者发生主要动脉粥样血栓性血管事件（急性肢体缺血（ALI）、非外伤性下肢大截肢、心肌梗死（MI）、缺血性卒中和心血管（CV）相关死亡）的风险增加。本研究评估了在真实世界中，PAD 患者血运重建后发生主要动脉粥样血栓性血管事件、静脉血栓栓塞（VTE）事件和随后下肢血运重建的发生率。
从 Optum Clinformatics Data Mart 索赔数据库（2014 年第一季度至 2019 年第二季度）中确定年龄≥50 岁、接受外周血运重建的 PAD 患者。PAD 诊断后的第一次下肢血运重建被定义为索引日期。在随访期间，通过事件数量除以观察患者年（以首次事件为截止点）来评估主要动脉粥样血栓性血管事件（即 ALI、非外伤性下肢大截肢、MI、缺血性卒中和 CV 相关死亡的复合事件）和 VTE 的发生率。总体上估计了随后血运重建和 VTE 的发生率，并比较了发生主要动脉粥样血栓性血管事件和未发生主要动脉粥样血栓性血管事件的患者之间的发生率。
在 38439 例患者中，38439 例中有 6675 例（17.4%）在中位随访 1.0 年期间发生主要动脉粥样血栓性血管事件。复合主要动脉粥样血栓性血管和 VTE 的发生率分别为 13.81/100 患者年和 1.77/100 患者年，40.2%的患者发生了随后的血运重建。血运重建后发生主要动脉粥样血栓性血管事件的患者随后血运重建（64.6%比 35.1%，标准化差值[SD]≥10%）和 VTE（4.6%比 2.1%，SD≥10%）的发生率明显更高。
年龄≥50 岁、接受外周血运重建的 PAD 患者中，每 6 例患者中就有 1 例在 1 年内发生主要动脉粥样血栓性血管事件，因此与血运重建后未发生主要动脉粥样血栓性血管事件的患者相比，发生随后血运重建和 VTE 的比例更高。这些发现强调需要改进策略，以预防血运重建后发生主要动脉粥样血栓性血管事件。
