Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Clinical Investigation Center, Hôpital Européen George-Pompidou, AP-HP, Paris, France.
Medical Information department, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
J Med Vasc. 2022 Feb;47(1):19-26. doi: 10.1016/j.jdmv.2022.02.001. Epub 2022 Mar 2.
Patients with critical limb ischemia (CLI) present a high risk of cardiovascular events and death. This study aimed to investigate the incidence of major adverse cardiovascular events (MACE) and one-year mortality in patients undergoing percutaneous revascularization procedure for CLI.
This investigation is a retrospective analysis of an ongoing cohort study in patients with CLI undergoing endovascular revascularization, hospitalized in the vascular medicine department from November 2013 to December 2018. Major cardiovascular events were collected during the first year after revascularization procedure and were defined as heart failure, acute coronary syndrome, ischemic stroke and sudden death. Mortality and major limb amputations, defined as above-the-ankle amputation, were determined during the one-year follow-up period. Multivariate logistic regression analyses were performed to identify factors independently associated with the occurrence of MACE and one-year mortality after revascularization procedure. A P≤0.05 was considered as statistically significant.
The study included 285 consecutive patients, 157 men (55%) and 128 women (45%), with a mean age of 77.8±12 years. Treated hypertension was present in 222 (78%) patients; diabetes was present in 137 (48%) patients; 112 (39%) patients had known coronary heart disease and 20 (7%) patients were dialysis dependent. During the one-year follow-up after revascularization procedure, 75 (26.3%) patients presented an incident cardiovascular event, of whom 19 (6.7%) patients in the perioperative period. Cumulative mortality rate was 26.7% (76 patients) mostly from cardiovascular causes. Twenty-five patients (8.8%) experienced major amputation. In multivariate analysis, the occurrence of MACE was associated with an increased mortality risk (HR 6.96 (2.99-16.94), P<0.001). Other variables associated with an increased mortality were living in a nursing home and malnutrition. Decompensated heart failure and coronary heart disease were both associated with incident MACE in multivariate analysis, independently of confounders.
In the present study population, incident MACE were prevalent in the year following endovascular revascularization procedure in patients with CLI and were associated with an increased risk of mortality. Coronary heart disease and decompensated heart failure are important contributors for the occurrence of MACE. In this elderly patient population with CLI, these results should be taken into account during the multidisciplinary team meeting before consideration of revascularization procedure.
患有严重肢体缺血（CLI）的患者存在心血管事件和死亡的高风险。本研究旨在探讨 CLI 患者行经皮血运重建术的主要不良心血管事件（MACE）和 1 年死亡率。
这是一项对 2013 年 11 月至 2018 年 12 月期间在血管医学科住院行血管内血运重建术的 CLI 患者进行的回顾性队列研究的分析。在血管重建术后的第一年收集主要心血管事件，并将其定义为心力衰竭、急性冠状动脉综合征、缺血性卒中和猝死。在 1 年随访期间确定死亡率和主要肢体截肢率，定义为踝上截肢。采用多变量逻辑回归分析确定与血管重建术后 MACE 和 1 年死亡率发生相关的独立因素。P≤0.05 被认为具有统计学意义。
该研究纳入了 285 例连续患者，其中男性 157 例（55%），女性 128 例（45%），平均年龄为 77.8±12 岁。222 例（78%）患者存在治疗性高血压；137 例（48%）患者患有糖尿病；112 例（39%）患者存在已知的冠心病，20 例（7%）患者依赖透析。在血管重建术后的 1 年随访期间，75 例（26.3%）患者发生心血管事件，其中 19 例（6.7%）发生在围手术期。累积死亡率为 26.7%（76 例），主要死于心血管原因。25 例（8.8%）患者发生主要截肢。多变量分析显示，MACE 的发生与死亡率增加相关（HR 6.96（2.99-16.94），P<0.001）。其他与死亡率增加相关的变量包括居住在疗养院和营养不良。失代偿性心力衰竭和冠心病在多变量分析中均与 MACE 事件相关，独立于混杂因素。
在本研究人群中，CLI 患者行血管内血运重建术后 1 年内发生 MACE 的情况较为常见，且与死亡率增加相关。冠心病和失代偿性心力衰竭是发生 MACE 的重要因素。在 CLI 这一老年患者人群中，在考虑血管重建术之前，应在多学科团队会议上考虑这些结果。
