46807Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Cardiology Unit, 9299Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy.
J Cardiovasc Pharmacol Ther. 2022 Jan-Dec;27:10742484221101980. doi: 10.1177/10742484221101980.
Medical therapy for secondary prevention is known to be under-used in patients with peripheral artery disease (PAD). Few data are available on the subgroup with critical limb ischemia (CLI). Prescription of cardiovascular preventive therapies was recorded at discharge in a large, prospective cohort of patients admitted for treatment of CLI and foot lesions, stratified for coronary artery disease (CAD) diagnosis. All patients were followed up for at least 1 year. The primary endpoint was major adverse cardiovascular events (MACE). 618 patients were observed for a median follow-up of 981 days. Renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, beta-blockers, and antithrombotic drugs were prescribed in 52%, 80%, 51%, and 99% of patients, respectively. However, only 43% of patients received optimal medical therapy (OMT), defined as the combination of RAAS inhibitor plus statin plus at least one antithrombotic drug. It was observed that the prescription of OMT was not affected by the presence of a CAD diagnosis. On the other hand, it was noticed that the renal function affected the prescription of OMT. OMT was independently associated with MACE (HR 0.688, 95%CI 0.475-0.995, = .047) and, after propensity matching, also with all-cause mortality (HR 0.626, 95%CI 0.409-0.958, = .031). Beta-blockers prescription was not associated with any outcome. In conclusion, patients with critical limb ischemia are under-treated with cardiovascular preventive therapies, irrespective of a CAD diagnosis. This has consequences on their prognosis.
医学疗法在治疗外周动脉疾病（PAD）患者中应用不足。有关合并严重肢体缺血（CLI）的亚组数据较少。在一项大型前瞻性 CLI 患者和足部病变治疗队列中，记录了出院时心血管预防治疗的处方情况，同时对冠心病（CAD）诊断进行分层。所有患者均至少随访 1 年。主要终点为主要不良心血管事件（MACE）。618 例患者的中位随访时间为 981 天。肾素-血管紧张素-醛固酮系统（RAAS）抑制剂、他汀类药物、β受体阻滞剂和抗血栓药物在分别有 52%、80%、51%和 99%的患者中开具。然而，只有 43%的患者接受了最佳药物治疗（OMT），定义为 RAAS 抑制剂加他汀类药物加至少一种抗血栓药物的联合治疗。观察到 OMT 的处方不受 CAD 诊断的影响。另一方面，发现肾功能会影响 OMT 的处方。OMT 与 MACE 独立相关（HR 0.688，95%CI 0.475-0.995，P=0.047），且在倾向匹配后，也与全因死亡率独立相关（HR 0.626，95%CI 0.409-0.958，P=0.031）。β受体阻滞剂的处方与任何结局均无关。总之，无论 CAD 诊断如何，CLI 患者的心血管预防治疗都不足，这对其预后有影响。
