Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Psychology Section, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
JACC Cardiovasc Interv. 2023 Feb 13;16(3):332-343. doi: 10.1016/j.jcin.2022.09.022.
Lack of guideline-directed medical therapy (GDMT) in patients undergoing peripheral vascular interventions (PVIs) may increase mortality and amputation risk.
The authors sought to study the association between GDMT and mortality/amputation and to examine GDMT variability among providers and health systems.
We performed an observational study using patients in the Vascular Quality Initiative registry undergoing PVI between 2017 and 2018. Two-year all-cause mortality and major amputation data were derived from Medicare claims data. Compliance with GDMT was defined as receiving a statin, antiplatelet therapy, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker if hypertensive. Propensity 1:1 matching was applied for GDMT vs no GDMT and survival analyses were performed to compare outcomes between groups.
Of 15,891 patients undergoing PVIs, 48.8% received GDMT and 6,120 patients in each group were matched. Median follow-up was 9.6 (IQR: 4.5-16.2) months for mortality and 8.4 (IQR: 3.5-15.4) for amputation. Mean age was 72.0 ± 9.9 years. Mortality risk was higher among patients who did not receive GDMT versus those on GDMT (31.2% vs 24.5%; HR: 1.37, 95% CI: 1.25-1.50; P < 0.001), as well as, risk of amputation (16.0% vs 13.2%; HR: 1.20; 95% CI: 1.08-1.35; P < 0.001). GDMT rates across sites and providers ranging from 0% to 100%, with lower performance translating into higher risk.
Almost one-half of the patients receiving PVI in this national quality registry were not on GDMT, and this was associated with increased risk of mortality and major amputation. Quality improvement efforts in vascular care should focus on GDMT in patients undergoing PVI.
在外周血管介入治疗（PVI）患者中缺乏指南指导的医学治疗（GDMT）可能会增加死亡率和截肢风险。
作者旨在研究 GDMT 与死亡率/截肢率之间的关系，并检查提供者和医疗系统之间 GDMT 的变异性。
我们使用 2017 年至 2018 年期间在血管质量倡议登记处接受 PVI 的患者进行了一项观察性研究。来自医疗保险索赔数据的 2 年全因死亡率和主要截肢数据。如果高血压，GDMT 的定义是接受他汀类药物、抗血小板治疗和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂。应用倾向 1:1 匹配进行 GDMT 与无 GDMT 比较，并进行生存分析比较两组间的结局。
在 15891 例接受 PVI 的患者中，48.8%接受了 GDMT，每组有 6120 例患者进行匹配。死亡率的中位随访时间为 9.6（IQR：4.5-16.2）个月，截肢率的中位随访时间为 8.4（IQR：3.5-15.4）个月。平均年龄为 72.0±9.9 岁。与接受 GDMT 的患者相比，未接受 GDMT 的患者死亡率更高（31.2%比 24.5%；HR：1.37，95%CI：1.25-1.50；P<0.001），截肢风险也更高（16.0%比 13.2%；HR：1.20；95%CI：1.08-1.35；P<0.001）。各站点和提供者的 GDMT 率从 0%到 100%不等，表现较低的与较高的风险相关。
在这个全国质量登记处接受 PVI 的患者中，近一半没有接受 GDMT，这与死亡率和主要截肢风险增加有关。血管护理的质量改进工作应集中在接受 PVI 的患者的 GDMT 上。
