Tsolaki Elpiniki, Traina Luca, Savriè Caterina, Guerzoni Franco, Napoli Nicola, Manfredini Roberto, Taddia Maria Cristina, Manfredini Fabio, Lamberti Nicola
Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy.
Clinica Medica Unit, University Hospital of Ferrara, 44124 Ferrara, Italy.
Rev Cardiovasc Med. 2024 Jun 24;25(6):229. doi: 10.31083/j.rcm2506229. eCollection 2024 Jun.
Peripheral artery disease (PAD) is recognized as a significant contributor to the public health burden in the cardiovascular field and has a significant rate of morbidity and mortality. In the intermediate stages, exercise therapy is recommended by the guidelines, although supervised programs are scarcely available. This single-center observational study aimed to evaluate the long-term outcomes of patients with PAD and claudication receiving optimal medical care and follow-up or revascularization procedures or structured home-based exercise.
The records of 1590 PAD patients with claudication were assessed at the Vascular Surgery Unit between 2008 and 2017. Based on the findings of the recruitment visit, patients were assigned to one of the three following groups according to the available guidelines: Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The exercise program was prescribed at the hospital and executed at home with two daily 10-minute interval walking sessions at a pain-free speed. The number and date of deaths, all-cause hospitalizations, and peripheral revascularizations for 5 years were collected from the Emilia-Romagna regional database.
At entry, 137 patients underwent revascularization; 1087 patients were included in the Ex group, and 366 were included in the Co group. At baseline, patients in the Rev group were significantly younger and had fewer comorbidities ( 0.001). A propensity score matching analysis was performed, and three balanced subgroups of 119 patients were each created. The mortality rate was significantly ( 0.001) greater in the Co (45%) group than in the Rev (11%) and Ex (11%) groups, as was the incidence of all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; 0.001). There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%; Ex 11%).
In PAD patients with claudication, both revascularization procedures and structured home-based exercise sessions are associated with better long-term clinical outcomes than walking advice and follow-up only.
外周动脉疾病（PAD）被认为是心血管领域公共卫生负担的重要因素，其发病率和死亡率都很高。在疾病中期，指南推荐进行运动疗法，尽管几乎没有监督项目。这项单中心观察性研究旨在评估接受最佳医疗护理和随访、血管重建手术或结构化家庭运动的PAD和间歇性跛行患者的长期预后。
对2008年至2017年间血管外科收治的1590例PAD间歇性跛行患者的记录进行评估。根据招募访视的结果，按照现有指南将患者分为以下三组之一：血管重建术（Rev）组、结构化运动疗法（Ex）组或对照组（Co）。运动计划在医院制定，患者在家中以无痛速度每天进行两次，每次间隔10分钟的步行训练。从艾米利亚 - 罗马涅地区数据库收集5年期间的死亡人数和日期、全因住院情况以及外周血管重建情况。
入组时，137例患者接受了血管重建术；1087例患者纳入Ex组，366例患者纳入Co组。基线时，Rev组患者明显更年轻，合并症更少（P<0.001）。进行了倾向评分匹配分析，每组创建了119例患者的三个平衡亚组。Co组（45%）的死亡率显著高于Rev组（11%）和Ex组（11%）（P<0.001），全因住院发生率也是如此（Co组：95%；Rev组56%；Ex组60%；P<图注：0.001）。外周血管重建情况无差异（Co组：19%；Rev组：17%；Ex组11%）。
在患有间歇性跛行的PAD患者中，血管重建手术和结构化家庭运动训练与仅给予步行建议和随访相比，均具有更好的长期临床预后。
