Takei Tatsuro, Tokuda Takahiro, Yoshioka Naoki, Ogata Kenji, Tanaka Akiko, Kojima Shunsuke, Yamaguchi Kohei, Yanagiuchi Takashi, Nakama Tatsuya
Department of Cardiology, Tenyoukai Central Hospital.
Department of Cardiology, Nagoya Heart Center.
J Atheroscler Thromb. 2025 Jul 1;32(7):863-872. doi: 10.5551/jat.65379. Epub 2024 Dec 25.
Few studies have evaluated the midterm prognosis of patients with intermittent claudication who underwent endovascular therapy (EVT) for femoropopliteal lesions. Therefore, we aimed to assess 2-year mortality and prognostic factors in these patients.
We retrospectively analyzed 947 patients who underwent EVT for intermittent claudication between January 2018 and December 2021 at eight Japanese cardiovascular centers. Kaplan-Meier survival analysis was performed for mortality, and prognostic factors were analyzed using the Cox proportional hazards regression model. Patient backgrounds and medications were included in the investigation of prognostic factors.
Notably, 79 deaths occurred during the mean follow-up period of 20.9±6.2 months. The 2-year mortality rate was 9.1%. In multivariate analysis, body mass index (BMI) ＜18.5 kg/m (p＜0.001), coronary artery disease (CAD) (p＜0.001), dialysis (p＜0.001), and ankle-brachial pressure index (ABI) ＜0.6 (p=0.012) were risk factors. Statins and cilostazol were protective factors (p=0.014 and p=0.036, respectively). When the study population was stratified based on the number of these risk factors, the mortality rate was highest (32.5% at 2 years) in patients with at least three risk factors. However, when stratified according to protective factors, the mortality rate was lowest in patients with two protective factors (2.1% at 2 years).
Dialysis, low BMI, CAD, and low ABI were risk factors for a worse 2-year prognosis in patients with intermittent claudication who underwent EVT for femoropopliteal lesions. Statins and cilostazol may improve the 2-year prognosis of patients with lower extremity artery disease.
很少有研究评估接受股腘动脉病变血管内治疗（EVT）的间歇性跛行患者的中期预后。因此，我们旨在评估这些患者的2年死亡率和预后因素。
我们回顾性分析了2018年1月至2021年12月期间在日本8个心血管中心接受EVT治疗间歇性跛行的947例患者。采用Kaplan-Meier生存分析评估死亡率，并使用Cox比例风险回归模型分析预后因素。在预后因素调查中纳入了患者背景和用药情况。
值得注意的是，在平均随访期20.9±6.2个月期间发生了79例死亡。2年死亡率为9.1%。多因素分析显示，体重指数（BMI）＜18.5 kg/m（p＜0.001）、冠状动脉疾病（CAD）（p＜0.001）、透析（p＜0.001）和踝臂压力指数（ABI）＜0.6（p=0.012）是危险因素。他汀类药物和西洛他唑是保护因素（分别为p=0.014和p=0.036）。当根据这些危险因素的数量对研究人群进行分层时，至少有三个危险因素的患者死亡率最高（2年时为32.5%）。然而，根据保护因素进行分层时，有两个保护因素的患者死亡率最低（2年时为2.1%）。
透析、低BMI、CAD和低ABI是接受股腘动脉病变EVT治疗的间歇性跛行患者2年预后较差的危险因素。他汀类药物和西洛他唑可能改善下肢动脉疾病患者的2年预后。
