Soga Yoshimitsu, Takahara Mitsuyoshi, Iida Osamu, Suzuki Kenji, Mori Shinsuke, Kawasaki Daizo, Haraguchi Kazuki, Yamaoka Terutoshi, Ando Kenji
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
JACC Asia. 2025 Sep;5(9):1187-1195. doi: 10.1016/j.jacasi.2025.03.013. Epub 2025 May 27.
Although several predictors affect long-term mortality in patients with lower extremity artery disease, long-term association of predictors on mortality over time remain unclear.
The aim of this study was to explore the long-term and time-dependent association of baseline characteristics with mortality in patients with iliofemoral arterial disease.
This study is a multicenter retrospective analysis of 4,086 consecutive patients (mean age 72 ± 9 years, 74% men) who underwent endovascular therapy for symptomatic de novo iliofemoral arterial disease between January 2004 and December 2011 at 16 cardiovascular centers in Japan.
During the median follow-up of 3.8 years (Q1-Q3: 1.4-7.4 years), 1,100 deaths, and 637 major adverse cardiovascular events (MACE) (defined as death, myocardial infarction, and stroke) were observed. Overall survival and MACE-free rates were estimated to be 56.1% and 50.6% at 10 years. Old age, chronic kidney disease stage, heart failure, the lack of renin-angiotensin-system inhibitor use, chronic limb threatening ischemia (CLTI), decreased ankle-brachial index, femoropopliteal lesion were significantly associated with an increased risk of mortality. while the prognostic impact of CLTI was significantly attenuated afterwards. Old age, chronic kidney disease stage, cerebrovascular disease, coronary artery disease, heart failure, warfarin use, the lack of statin use, and CLTI were significantly associated with an increased risk of MACE, while the prognostic impact of cerebrovascular disease and CLTI was significantly attenuated afterwards.
This study demonstrated long-term and time-dependent association of predictors on mortality and MACE following endovascular therapy. It highlights the need for continuous management of cardiovascular risk factors in this high-risk population.
尽管有多种预测因素影响下肢动脉疾病患者的长期死亡率，但预测因素与死亡率随时间的长期关联仍不明确。
本研究旨在探讨基线特征与髂股动脉疾病患者死亡率的长期及时间依赖性关联。
本研究是一项多中心回顾性分析，纳入了2004年1月至2011年12月期间在日本16个心血管中心因症状性初发髂股动脉疾病接受血管内治疗的4086例连续患者（平均年龄72±9岁，74%为男性）。
在中位随访3.8年（四分位间距：1.4 - 7.4年）期间，观察到1100例死亡和637例主要不良心血管事件（MACE，定义为死亡、心肌梗死和卒中）。10年时的总生存率和无MACE率估计分别为56.1%和50.6%。高龄、慢性肾脏病分期、心力衰竭、未使用肾素 - 血管紧张素系统抑制剂、慢性肢体威胁性缺血（CLTI）、踝肱指数降低、股腘病变与死亡风险增加显著相关，而CLTI的预后影响随后显著减弱。高龄、慢性肾脏病分期、脑血管疾病、冠状动脉疾病、心力衰竭、使用华法林、未使用他汀类药物和CLTI与MACE风险增加显著相关，而脑血管疾病和CLTI的预后影响随后显著减弱。
本研究证明了血管内治疗后预测因素与死亡率和MACE的长期及时间依赖性关联。它强调了在这一高危人群中持续管理心血管危险因素的必要性。
