University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
Eur J Vasc Endovasc Surg. 2023 Oct;66(4):550-559. doi: 10.1016/j.ejvs.2023.06.018. Epub 2023 Jun 22.
Chronic limb threatening ischaemia (CLTI) has a devastating prognosis with high rates of lower limb amputation (LLA) and deaths. This is an illustration of contemporary management and the long term fate of patients after ischaemic LLA, particularly with respect to sex, using real world data.
This was a multisectoral cross sectional and longitudinal analysis of health claims data from the largest German health insurance database (AOK). Data of 39 796 propensity score matched patients hospitalised for ischaemic LLA between 2010 and 2018 were analysed for cardiovascular comorbidities, treatment, and for subsequent cardiovascular and limb events, with a distinct focus on sex. Matching was performed, to ensure that the rate of major amputations and the age distribution were equal in both groups (in both sexes). An observation period of two years before index and a follow up (FU) period until 2019 were included.
Before index amputation, 68% of patients had received any kind of peripheral revascularisation. The use of statins (37.0% vs. 42.6%) and antithrombotic substances (54.9% vs. 61.8%) was lower in women than in men (p < .001). During two year FU, cardiovascular and limb events occurred among women and men as follows: limb re-amputation (26.7% vs. 31.2%), myocardial infarction (10.9% vs. 14.5%), stroke (20.8% vs. 20.7%), and death from any cause (51.0% vs. 53.3%, p < .001 except for stroke). After adjustment for cardiovascular comorbidities and vascular procedures, female sex was associated with a higher probability of death (HR 1.04, 95% CI 1.04 - 1.04).
Patients undergoing ischaemic LLA still have a poor prognosis marked by high rates of recurrent cardiovascular and limb events resulting in a > 50% mortality rate within two years. The continuous lack of guideline recommended therapies, particularly in women, may be associated with the persisting poor outcome, necessitating urgent further investigation.
慢性肢体威胁性缺血（CLTI）具有破坏性的预后，下肢截肢（LLA）和死亡的发生率很高。这是对目前缺血性LLA 后患者管理和长期预后的说明，特别是在涉及性别时，使用真实世界的数据。
这是对最大的德国健康保险数据库（AOK）中的健康索赔数据进行的多部门横断面和纵向分析。对 2010 年至 2018 年因缺血性 LLA 住院的 39796 名倾向评分匹配患者进行心血管合并症、治疗以及随后的心血管和肢体事件的数据进行了分析，特别关注性别。进行匹配是为了确保两组（男女）的主要截肢率和年龄分布相等。包括指数前两年的观察期和 2019 年的随访期。
在指数截肢前，68%的患者接受过任何形式的外周血管重建。与男性相比，女性接受他汀类药物（37.0%比 42.6%）和抗血栓物质（54.9%比 61.8%）的比例较低（p<0.001）。在两年的随访期间，女性和男性发生以下心血管和肢体事件：肢体再截肢（26.7%比 31.2%）、心肌梗死（10.9%比 14.5%）、中风（20.8%比 20.7%）和任何原因的死亡（51.0%比 53.3%，除中风外，p<0.001）。在调整心血管合并症和血管手术后，女性性别与更高的死亡概率相关（HR 1.04，95%CI 1.04-1.04）。
接受缺血性 LLA 的患者预后仍然较差，其标志是复发的心血管和肢体事件发生率较高，导致两年内死亡率超过 50%。持续缺乏指南推荐的治疗方法，特别是在女性中，可能与持续较差的预后有关，需要紧急进一步调查。
