Elsayed Nadin, Straus Sabrina L, Clouse Darrin, Motaganahalli Raghu L, Malas Mahmoud
Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, CA.
Division of Vascular and Endovascular Surgery, University of Virginia Medical Center, Charlottesville, VA.
J Vasc Surg. 2025 Jan;81(1):229-234.e1. doi: 10.1016/j.jvs.2024.09.008. Epub 2024 Sep 19.
In the Heart Outcomes Prevention Evaluation study, investigators found that ramipril was associated with improved survival as well as decreased MI and stroke rates in patients with peripheral arterial disease. Nonetheless, their effect on chronic limb-threatening ischemia (CLTI)-specific outcomes is unclear. We aim to assess the effect of ACEIs/ARBs on amputation-free survival in patients with CLTI undergoing peripheral vascular intervention (PVI) in a Medicare-linked database.
Patients undergoing PVI in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database were included. Primary outcomes included amputation-free survival. Kaplan-Meier survival and multivariable Cox regression analyses were used to assess 1-year outcomes.
A total of 34,284 patients were included, 46.3% of whom were discharged on ACEIs/ARBs. Patients discharged on ACEIs/ARBs were more likely to be smokers, have diabetes, and have hypertension. They were also more likely to present with rest pain. The overall 1-year survival rate for patients on ACEIs/ARBs vs those who are not was (79.1% vs 69.4%; P < .001). Freedom from amputation was 87.8% for patients on ACEIs/ARBs vs 84.2% for those who were not (P < .001). Amputation-free survival was 70.5% vs 59.5% for ACEIs/ARBs vs no ACEIs/ARBs (P < .001). After adjusting for potential confounders, ACEIs/ARBs use was associated with lower 1-year mortality (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.7-0.8; P < .001), amputation (HR, 0.89; 95% CI, 0.8-0.9; P < .001), and amputation or death (HR, 0.79; 95% CI, 0.76-0.8; P < .001).
ACEIs/ARBs were associated independently with lower amputation, improved survival, and amputation-free rates survival at 1 year in patients with CLTI undergoing PVI. The fact that more than one-half the patients were not discharged on these medications presents an area for potential quality improvement.
在心脏结局预防评估研究中，研究人员发现雷米普利与外周动脉疾病患者生存率提高以及心肌梗死和中风发生率降低相关。尽管如此，其对慢性肢体威胁性缺血（CLTI）特定结局的影响尚不清楚。我们旨在评估在一个与医疗保险相关的数据库中，血管紧张素转换酶抑制剂（ACEIs）/血管紧张素Ⅱ受体阻滞剂（ARBs）对接受外周血管介入治疗（PVI）的CLTI患者无截肢生存率的影响。
纳入血管质量倡议血管植入监测和介入结局网络数据库中接受PVI的患者。主要结局包括无截肢生存率。采用Kaplan-Meier生存分析和多变量Cox回归分析评估1年结局。
共纳入34284例患者，其中46.3%出院时使用ACEIs/ARBs。出院时使用ACEIs/ARBs的患者更可能是吸烟者、患有糖尿病和高血压。他们也更可能出现静息痛。使用ACEIs/ARBs的患者与未使用者相比，总体1年生存率分别为79.1%和69.4%（P<0.001）。使用ACEIs/ARBs的患者无截肢率为87.8%，未使用者为84.2%（P<0.001）。使用ACEIs/ARBs与未使用相比，无截肢生存率分别为70.5%和59.5%（P<0.001）。在调整潜在混杂因素后，使用ACEIs/ARBs与较低的1年死亡率（风险比[HR]，0.77；95%置信区间[CI]，0.7-0.8；P<0.001）、截肢率（HR，0.89；95%CI，0.8-0.9；P<0.001）以及截肢或死亡率（HR，0.79；95%CI，0.76-0.8；P<0.001）相关。
在接受PVI的CLTI患者中，ACEIs/ARBs独立与较低的截肢率、改善的生存率以及1年无截肢生存率相关。超过一半的患者出院时未使用这些药物，这是一个潜在的质量改进领域。
