Erik Baubeta Fridh1, Manne Andersson2, Marcus Thuresson3, Birgitta Sigvant4, Björn Kragsterman5, Saga Johansson6, Pål Hasvold7, Joakim Nordanstig8, Mårten Falkenberg9. 1. Department of Radiology, Ryhov County Hospital, Jönköping, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. Electronic address: erik.fridh@gu.se. 2. Department of Vascular Surgery, Ryhov County Hospital, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 3. Statisticon AB, Uppsala, Sweden. 4. Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 5. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden. 6. Formerly AstraZeneca Gothenburg, Mölndal, Sweden. 7. AstraZeneca Nordic-Baltic, Södertälje, Sweden. 8. Department of Vascular Surgery and Institute of Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Gothenburg, Sweden. 9. Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.
Abstract
OBJECTIVE/ BACKGROUND: Chronic limb threatening ischaemia (CLTI) has a high risk of amputation and mortality. Increased knowledge on how sex, comorbidities, and medication influence these outcomes after revascularisation may help optimise results and patient selection. METHODS: This population based observational cohort study included all individuals revascularised for CLTI in Sweden during a five year period (10,617 patients in total). Data were retrieved and merged from mandatory national healthcare registries, and specifics on amputations were validated with individual medical records. RESULTS: Mean age at revascularisation was 76.8 years. Median follow up was 2.7 years (range 0-6.6 years). Male sex (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09-1.33), renal insufficiency (HR 1.57, 95% CI 1.32-1.87), diabetes (HR 1.45, 95% CI 1.32-1.60), and heart failure (HR 1.17, 95% CI 1.05-1.31) were independently associated with an increased amputation rate, whereas the use of statins (HR 0.71, 95% CI 0.64-0.78) and low dose acetylsalicylic acid (HR 0.77, 95% CI 0.70-0.86) were associated with a reduced amputation rate. For the combined end point of amputation or death, an association with increased rates was found for male sex (HR 1.25, 95% CI 1.18-1.32), renal insufficiency (HR 1.94, 95% CI 1.75-2.14), heart failure (HR 1.50, 95% CI 1.40-1.60), and diabetes (HR 1.31, 95% CI 1.23-1.38). The use of statins (HR 0.74, 95% CI 0.67-0.82) and low dose acetylsalicylic acid (HR 0.82, 95% CI 0.77-0.88]) were related to a reduced risk of amputation or death. CONCLUSIONS: Renal insufficiency is the strongest independent risk factor for both amputation and amputation/death in revascularised CLTI patients, followed by diabetes and heart failure. Men with CLTI have worse outcomes than women. These results may help govern patient selection for revascularisation procedures. Statin and low dose acetylsalicylic acid are associated with an improved limb outcome. This underlines the importance of preventive medication to reduce general cardiovascular risk and increase limb salvage.
OBJECTIVE/ BACKGROUND:Chronic limb threatening ischaemia (CLTI) has a high risk of amputation and mortality. Increased knowledge on how sex, comorbidities, and medication influence these outcomes after revascularisation may help optimise results and patient selection. METHODS: This population based observational cohort study included all individuals revascularised for CLTI in Sweden during a five year period (10,617 patients in total). Data were retrieved and merged from mandatory national healthcare registries, and specifics on amputations were validated with individual medical records. RESULTS: Mean age at revascularisation was 76.8 years. Median follow up was 2.7 years (range 0-6.6 years). Male sex (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09-1.33), renal insufficiency (HR 1.57, 95% CI 1.32-1.87), diabetes (HR 1.45, 95% CI 1.32-1.60), and heart failure (HR 1.17, 95% CI 1.05-1.31) were independently associated with an increased amputation rate, whereas the use of statins (HR 0.71, 95% CI 0.64-0.78) and low dose acetylsalicylic acid (HR 0.77, 95% CI 0.70-0.86) were associated with a reduced amputation rate. For the combined end point of amputation or death, an association with increased rates was found for male sex (HR 1.25, 95% CI 1.18-1.32), renal insufficiency (HR 1.94, 95% CI 1.75-2.14), heart failure (HR 1.50, 95% CI 1.40-1.60), and diabetes (HR 1.31, 95% CI 1.23-1.38). The use of statins (HR 0.74, 95% CI 0.67-0.82) and low dose acetylsalicylic acid (HR 0.82, 95% CI 0.77-0.88]) were related to a reduced risk of amputation or death. CONCLUSIONS:Renal insufficiency is the strongest independent risk factor for both amputation and amputation/death in revascularised CLTI patients, followed by diabetes and heart failure. Men with CLTI have worse outcomes than women. These results may help govern patient selection for revascularisation procedures. Statin and low dose acetylsalicylic acid are associated with an improved limb outcome. This underlines the importance of preventive medication to reduce general cardiovascular risk and increase limb salvage.
Authors: Thomas Groennebaek; Tine Borum Billeskov; Camilla Tvede Schytz; Nichlas Riise Jespersen; Hans Erik Bøtker; Rikke Kathrine Jentoft Olsen; Nikolaj Eldrup; Joachim Nielsen; Jean Farup; Frank Vincenzo De Paoli; Kristian Vissing Journal: Cells Date: 2020-02-28 Impact factor: 6.600
Authors: Erika Lilja; Anders Gottsäter; Mervete Miftaraj; Jan Ekelund; Björn Eliasson; Ann-Marie Svensson; Moncef Zarrouk; Stefan Acosta Journal: Vasc Med Date: 2021-05-18 Impact factor: 3.239