Wittig Tim, Pflug Toni, Schmidt Andrej, Scheinert Dierk, Steiner Sabine
Department of Angiology, University Hospital Leipzig, 04103 Leipzig, Germany.
Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich, University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany.
J Clin Med. 2023 Aug 6;12(15):5146. doi: 10.3390/jcm12155146.
Within this single-center cohort study, we investigated the impact of optimal medical therapy on all-cause mortality, major amputation-free survival and clinically driven target lesion revascularization (CD TLR) in 552 patients with peripheral arterial disease (PAD) undergoing endovascular infrapopliteal revascularization. From the overall cohort, 145 patients were treated for intermittent claudication (IC) and 407 were treated for critical limb ischemia (CLI). Optimal medical therapy (OMT) was defined as the presence of at least one antiplatelet agent, statin and ACE inhibitor or AT-2 antagonist based on guideline recommendations. About half (55.5%) of all patients were prescribed OMT at discharge, with a higher proportion in claudicants (62.1%) versus CLI patients (53.2%). Over three years of follow-up, survival was significantly better in patients with IC (80.6 ± 3.8% vs. 59.9 ± 2.9%; < 0.001). There was a signal towards better survival in those patients receiving OMT (log-rank = 0.09). Similarly, amputation-free survival (AFS) was significantly better in patients with IC ( = 0.004) and also in patients receiving OMT (78.8 ± 3.6%) compared to that in those without OMT (71.5 ± 4.2%; = 0.046). Freedom from CD TLR within three years was significantly better in the IC group ( = 0.002), but there were no statistically significant differences for CD TLR dependent on the presence of OMT ( = 0.79). In conclusion, there is still an important underuse of OMT in patients undergoing infrapopliteal interventions, which is even more pronounced in CLI despite a signal for its benefit regarding all-cause mortality and major amputation-free survival.
在这项单中心队列研究中，我们调查了最佳药物治疗对552例行血管腔内腘下血管重建术的外周动脉疾病（PAD）患者的全因死亡率、无大截肢生存期和临床驱动的靶病变血管重建术（CD TLR）的影响。在整个队列中，145例患者因间歇性跛行（IC）接受治疗，407例患者因严重肢体缺血（CLI）接受治疗。最佳药物治疗（OMT）定义为根据指南建议使用至少一种抗血小板药物、他汀类药物和ACE抑制剂或AT-2拮抗剂。所有患者中约一半（55.5%）在出院时接受了OMT治疗，跛行患者的比例更高（62.1%），而CLI患者的比例为53.2%。在三年的随访中，IC患者的生存率明显更高（80.6±3.8%对59.9±2.9%；P<0.001）。接受OMT的患者有生存更好的趋势（对数秩检验P=0.09）。同样，IC患者的无截肢生存期（AFS）明显更好（P=0.004），接受OMT的患者的无截肢生存期（78.8±3.6%）也比未接受OMT的患者更好（71.5±4.2%；P=0.046）。IC组三年内无CD TLR的情况明显更好（P=0.002），但CD TLR在是否存在OMT方面无统计学显著差异（P=0.79）。总之，在接受腘下介入治疗的患者中，OMT的使用仍存在重要的不足，在CLI患者中更为明显，尽管有迹象表明其在全因死亡率和无大截肢生存期方面有益。
