Department of Medicine University of California Irvine School of Medicine Orange CA.
Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.
J Am Heart Assoc. 2022 Feb 15;11(4):e022232. doi: 10.1161/JAHA.121.022232. Epub 2022 Feb 8.
Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD-specific health status around the time of diagnosis may prognosticate long-term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3-month, and change from baseline to 3-month follow-up. Kaplan-Meier using 3-month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5-year all-cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3-month, respectively), 141 (19.8%) died over a median follow-up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per-10-point increment; 95% CI, 0.84-0.97; =0.008), 3-month (HR [95% CI], 0.87 [0.82-0.93]; <0.001) and change in PAQ (HR [95% CI], 0.92 [0.85-0.99]; =0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3-month PAQ was more strongly associated with mortality than either baseline (3-month HR [95% CI], 0.85 [0.78-0.92]; <0.001; C-statistic, 0.77) or change (3-month HR [95% CI], 0.79 [0.72-0.87]; <0.001). Conclusions PAD-specific health status is independently associated with 5-year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.
外周动脉疾病（PAD）与心血管发病率增加相关，死亡率仍然很高且难以预测，因此准确了解诊断时的连续 PAD 特定健康状况可能有助于预测长期死亡风险。
本研究纳入了 2011 年至 2015 年期间在 10 个美国站点参与 PORTRAIT 登记研究的新出现或恶化的 PAD 症状患者。基线、3 个月时采用外周动脉问卷（PAQ）综合评分评估健康状况，并比较基线至 3 个月随访时的变化。采用 Kaplan-Meier 法构建 3 个月时间点的 landmark 模型和分层 Cox 回归模型，以评估 PAQ 与 5 年全因死亡率的相关性。在 711 例患者（平均年龄 68.8±9.6 岁，40.9%为女性，72.7%为白人；基线和 3 个月时的平均 PAQ 分别为 47.5±22.0 和 65.9±25.0）中，中位随访 4.1 年后有 141 例（19.8%）死亡。在未调整模型中，基线（HR，每增加 10 分下降 0.90；95%CI，0.84-0.97；=0.008）、3 个月（HR [95%CI]，0.87 [0.82-0.93]；<0.001）和 PAQ 变化（HR [95%CI]，0.92 [0.85-0.99]；=0.021）均与死亡率相关。在包括评分组合的完全调整模型中，3 个月 PAQ 与死亡率的相关性强于基线（3 个月 HR [95%CI]，0.85 [0.78-0.92]；<0.001；C 统计量，0.77）或变化（3 个月 HR [95%CI]，0.79 [0.72-0.87]；<0.001）。
新出现或恶化的 PAD 症状患者的 PAD 特定健康状况与 5 年生存率独立相关，最近的评估结果最具预后意义。未来需要进一步研究如何积极利用这些信息来优化治疗。
