Connie N Hess1, R Kevin Rogers2, Tracy Y Wang3, Rao Fu4, Jacob Gundrum4, Nancy M Allen LaPointe5, William R Hiatt6. 1. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; CPC Clinical Research, Aurora, Colorado. Electronic address: connie.hess@ucdenver.edu. 2. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. 3. Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. 4. Premier, Charlotte, North Carolina. 5. Duke Clinical Research Institute, Durham, North Carolina; Premier, Charlotte, North Carolina. 6. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; CPC Clinical Research, Aurora, Colorado.
Abstract
BACKGROUND: Revascularization is important for symptom treatment and limb salvage in peripheral artery disease, yet little data exist on the incidence of post-procedure major adverse limb events (MALE) and longer-term outcomes. OBJECTIVES: This study sought to characterize hospitalizations and outpatient endovascular revascularizations after peripheral artery revascularization, assess temporal trends for outcomes, and identify factors associated with subsequent MALE hospitalization. METHODS: Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2014, in the Premier Healthcare Database were examined for the primary outcome of 1-year MALE hospitalization. Secondary outcomes included 1-year outpatient endovascular revascularization and limb-related, cardiovascular, and all-cause inpatient hospitalizations. Multivariable logistic regression was used to identify factors associated with 1-year MALE hospitalization. RESULTS: Among 381,415 revascularized patients, within 1 year post-index revascularization, 10.3% (n = 10,182) had a hospitalization for MALE, 11.0% (n = 42,056) had an outpatient endovascular revascularization, 18.8% (n = 71,663) had a limb-related hospitalization, 12.8% (n = 48,875) had a cardiovascular hospitalization, and 38.9% (n = 148,457) had any inpatient hospitalization. Over the study period, limb-related, cardiovascular, and all-cause hospitalizations decreased, whereas rates of outpatient endovascular revascularizations increased. Male sex, black race, Medicare and Medicaid insurance, diabetes, renal insufficiency, heart failure, smoking, baseline critical or acute limb ischemia, surgical revascularization, and noncardiology operator specialty were significantly associated with increased risk of MALE hospitalization. CONCLUSIONS: In contemporary practice, hospitalization for MALE occurs in 1 in 10 patients within 1 year after peripheral revascularization and is associated with patient and procedural factors. These data may inform efforts to improve post-procedure outcomes and limb-related clinical trial design.
BACKGROUND: Revascularization is important for symptom treatment and limb salvage in peripheral artery disease, yet little data exist on the incidence of post-procedure major adverse limb events (MALE) and longer-term outcomes. OBJECTIVES: This study sought to characterize hospitalizations and outpatient endovascular revascularizations after peripheral artery revascularization, assess temporal trends for outcomes, and identify factors associated with subsequent MALE hospitalization. METHODS:Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2014, in the Premier Healthcare Database were examined for the primary outcome of 1-year MALE hospitalization. Secondary outcomes included 1-year outpatient endovascular revascularization and limb-related, cardiovascular, and all-cause inpatient hospitalizations. Multivariable logistic regression was used to identify factors associated with 1-year MALE hospitalization. RESULTS: Among 381,415 revascularized patients, within 1 year post-index revascularization, 10.3% (n = 10,182) had a hospitalization for MALE, 11.0% (n = 42,056) had an outpatient endovascular revascularization, 18.8% (n = 71,663) had a limb-related hospitalization, 12.8% (n = 48,875) had a cardiovascular hospitalization, and 38.9% (n = 148,457) had any inpatient hospitalization. Over the study period, limb-related, cardiovascular, and all-cause hospitalizations decreased, whereas rates of outpatient endovascular revascularizations increased. Male sex, black race, Medicare and Medicaid insurance, diabetes, renal insufficiency, heart failure, smoking, baseline critical or acute limb ischemia, surgical revascularization, and noncardiology operator specialty were significantly associated with increased risk of MALE hospitalization. CONCLUSIONS: In contemporary practice, hospitalization for MALE occurs in 1 in 10 patients within 1 year after peripheral revascularization and is associated with patient and procedural factors. These data may inform efforts to improve post-procedure outcomes and limb-related clinical trial design.
Authors: David M Safley; Adam C Salisbury; Thomas T Tsai; Eric A Secemsky; Kevin F Kennedy; R Kevin Rogers; Faisal Latif; Nicolas W Shammas; Lawrence Garcia; Matthew A Cavender; Kenneth Rosenfield; Anand Prasad; John A Spertus Journal: JACC Cardiovasc Interv Date: 2021-02-08 Impact factor: 11.195
Authors: Jonathan D Newman; MacIntosh G Cornwell; Hua Zhou; Caron Rockman; Adriana Heguy; Yajaira Suarez; Henry S Cheng; Mark W Feinberg; Judith S Hochman; Kelly V Ruggles; Jeffrey S Berger Journal: Arterioscler Thromb Vasc Biol Date: 2021-03-04 Impact factor: 8.311
Authors: Robert S Rosenson; Qinzhong Chen; Sherwin D Najera; Prakash Krishnan; Martin L Lee; Daniel J Cho Journal: Cardiovasc Diabetol Date: 2019-06-07 Impact factor: 9.951
Authors: Minakshi P Biswas; Warren H Capell; Mary M McDermott; Donald L Jacobs; Joshua A Beckman; Marc P Bonaca; William R Hiatt Journal: JACC Basic Transl Sci Date: 2021-02-22
Authors: Stefano Barco; Tim Sebastian; Davide Voci; Rolf Peter Engelberger; Alexandru Grigorean; Erik Holy; Claudia Leeger; Mario Münger; Daniel Périard; Eliane Probst; Rebecca Spescha; Ulrike Held; Nils Kucher Journal: Trials Date: 2022-04-21 Impact factor: 2.728
Authors: Christian-Alexander Behrendt; Birgitta Sigvant; Jenny Kuchenbecker; Matthew J Grima; Marc Schermerhorn; Ian A Thomson; Martin Altreuther; Carlo Setacci; Alexei Svetlikov; Elin H Laxdal; Frederico Bastos Goncalves; Eric A Secemsky; E Sebastian Debus; Kevin Cassar; Barry Beiles; Adam W Beck; Kevin Mani; Daniel Bertges Journal: Eur J Vasc Endovasc Surg Date: 2020-09-29 Impact factor: 7.069