Kansai Rosai Hospital Cardiovascular Center, Inabaso.
Department of Surgery, Shinsuma General Hospital.
J Atheroscler Thromb. 2023 Jun 1;30(6):663-674. doi: 10.5551/jat.63773. Epub 2022 Aug 27.
This study aimed to investigate the long-term impact of guideline-directed medical therapy (GDMT) on 10-year mortality in patients with chronic limb-threatening ischaemia (CLTI) after revascularization.
We performed a retrospective multicentre study enrolle 459 patients with CLTI who underwent revascularization (396 endovascular therapy [EVT] and 63 bypass surgery [BSX] cases) between January 2007 and December 2011. The primary outcome measure was all-cause mortality. We additionally explored the predictors for all-cause mortality using Cox regression hazard models; the influence of GDMT, defined as prescription of antiplatelet agents, statins, and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in aggregate, on all-cause mortality, and the association between baseline characteristics using interaction effects.
During the 10-year follow-up after revascularization, 234 patients died. In Kaplan-Meier analysis, 10-year mortality was significantly lower in patients who received statins (p＜.001) and ACE inhibitors or ARBs (p=.010) than those who did not. However, there were no differences in 10-year mortality between patients who received anti-platelet agents and those who did not (p=.62). Interaction analysis revealed that GDMT had a significantly different hazard ratio in patients who were and were not on hemodialysis and in those treated with EVT or BSX (p for interaction =.002 and .044, respectively). In the multivariate analysis, age ＞75 years, non-ambulatory status, hemodialysis, congestive heart failure, left ventricular ejection fraction ＜50%, and GDMT were significantly associated with all-cause mortality.
Appropriate GDMT use was independently associated with 10-year mortality in patients with CLTI after revascularization.
本研究旨在探讨指南指导的医学治疗（GDMT）对血运重建后慢性肢体威胁性缺血（CLTI）患者 10 年死亡率的长期影响。
我们进行了一项回顾性多中心研究，纳入了 2007 年 1 月至 2011 年 12 月期间接受血运重建（396 例血管内治疗 [EVT] 和 63 例旁路手术 [BSX]）的 459 例 CLTI 患者。主要结局指标为全因死亡率。我们还使用 Cox 回归风险模型探讨了全因死亡率的预测因素；将 GDMT（定义为联合使用抗血小板药物、他汀类药物、血管紧张素转换酶 [ACE] 抑制剂或血管紧张素受体阻滞剂 [ARB]）定义为预测全因死亡率的因素，并使用交互作用效应探讨了基线特征之间的关系。
在血运重建后 10 年的随访期间，有 234 名患者死亡。在 Kaplan-Meier 分析中，接受他汀类药物治疗的患者（p＜0.001）和接受 ACE 抑制剂或 ARB 治疗的患者（p=0.010）的 10 年死亡率显著低于未接受治疗的患者。然而，接受抗血小板药物治疗的患者与未接受治疗的患者之间的 10 年死亡率无差异（p=0.62）。交互分析显示，GDMT 在接受血液透析和不接受血液透析的患者以及接受 EVT 或 BSX 治疗的患者中的风险比有显著差异（p 交互作用=0.002 和 0.044）。在多变量分析中，年龄＞75 岁、非步行状态、血液透析、充血性心力衰竭、左心室射血分数＜50%和 GDMT 与全因死亡率显著相关。
适当的 GDMT 使用与血运重建后 CLTI 患者的 10 年死亡率独立相关。
