Connie N Hess1, Tracy Y Wang2, Julia Weleski Fu3, Jacob Gundrum3, Nancy M Allen LaPointe3, R Kevin Rogers4, William R Hiatt5. 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. Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina. 3. Premier, Inc., Charlotte, North Carolina. 4. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. 5. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; CPC Clinical Research, Aurora, Colorado.
Abstract
BACKGROUND: Long-term cardiovascular and limb outcomes after revascularization for peripheral artery disease and, in particular, prognosis after post-procedure major adverse limb events (MALE) are not well-studied. OBJECTIVES: This study sought to describe outcomes after peripheral revascularization and assess relationships between post-procedure MALE hospitalization and subsequent events. METHODS: Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2015, in the Premier Healthcare Database were examined for the co-primary outcomes of interest, composite myocardial infarction (MI) or stroke and composite major amputation or peripheral revascularization. Multivariable adjusted Cox proportional hazards models with post-procedure MALE hospitalization included as a time-dependent covariate were developed to estimate hazard ratios for outcomes. RESULTS: Among 393,017 revascularized patients followed for a median of 2.7 years (interquartile range: 1.3 to 4.4 years), the cumulative incidence of MI or stroke was 9.8% and that of major amputation or peripheral revascularization was 41.9%. A total of 50,750 patients (12.9%) had at least 1 post-procedure MALE hospitalization. In time-dependent covariate adjusted models, post-procedure MALE hospitalization was associated with greater risk of subsequent MI or stroke (hazard ratio: 1.34; 95% confidence interval: 1.28 to 1.40) and major amputation or peripheral revascularization (hazard ratio: 8.13; 95% confidence interval: 7.96 to 8.29). After peripheral revascularization with or without post-procedure MALE hospitalization, risk of limb events increased rapidly post-procedure and more slowly after the first year, whereas cardiac risk increased steadily during follow-up. CONCLUSIONS: Revascularized peripheral artery disease patients face earlier limb and later cardiovascular ischemic risk that is heightened among patients with post-procedure MALE hospitalization. Increased provider awareness of these long-term risks may guide efforts to improve post-procedural outcomes.
BACKGROUND: Long-term cardiovascular and limb outcomes after revascularization for peripheral artery disease and, in particular, prognosis after post-procedure major adverse limb events (MALE) are not well-studied. OBJECTIVES: This study sought to describe outcomes after peripheral revascularization and assess relationships between post-procedure MALE hospitalization and subsequent events. METHODS:Patients undergoing peripheral artery revascularization between January 1, 2009, and September 30, 2015, in the Premier Healthcare Database were examined for the co-primary outcomes of interest, composite myocardial infarction (MI) or stroke and composite major amputation or peripheral revascularization. Multivariable adjusted Cox proportional hazards models with post-procedure MALE hospitalization included as a time-dependent covariate were developed to estimate hazard ratios for outcomes. RESULTS: Among 393,017 revascularized patients followed for a median of 2.7 years (interquartile range: 1.3 to 4.4 years), the cumulative incidence of MI or stroke was 9.8% and that of major amputation or peripheral revascularization was 41.9%. A total of 50,750 patients (12.9%) had at least 1 post-procedure MALE hospitalization. In time-dependent covariate adjusted models, post-procedure MALE hospitalization was associated with greater risk of subsequent MI or stroke (hazard ratio: 1.34; 95% confidence interval: 1.28 to 1.40) and major amputation or peripheral revascularization (hazard ratio: 8.13; 95% confidence interval: 7.96 to 8.29). After peripheral revascularization with or without post-procedure MALE hospitalization, risk of limb events increased rapidly post-procedure and more slowly after the first year, whereas cardiac risk increased steadily during follow-up. CONCLUSIONS: Revascularized peripheral artery diseasepatients face earlier limb and later cardiovascular ischemic risk that is heightened among patients with post-procedure MALE hospitalization. Increased provider awareness of these long-term risks may guide efforts to improve post-procedural outcomes.
Authors: Connie N Hess; Michael Szarek; Sonia S Anand; Rupert M Bauersachs; Manesh R Patel; E Sebastian Debus; Mark R Nehler; Warren H Capell; Joshua A Beckman; Gregory Piazza; Stanislav Henkin; Alessandra Bura-Rivière; Holger Lawall; Karel Roztocil; Judith Hsia; Eva Muehlhofer; Scott D Berkowitz; Lloyd P Haskell; Marc P Bonaca Journal: JAMA Netw Open Date: 2022-06-01
Authors: Scott D Berkowitz; Rupert M Bauersachs; Michael Szarek; Mark R Nehler; E Sebastian Debus; Manesh R Patel; Sonia S Anand; Warren H Capell; Connie N Hess; Judy Hsia; Nicholas J Leeper; David Brasil; Lajos Mátyás; Rafael Diaz; Marianne Brodmann; Eva Muehlhofer; Lloyd P Haskell; Marc P Bonaca Journal: J Thromb Haemost Date: 2022-03-07 Impact factor: 16.036
Authors: Laura Portas; Rupert Bauersachs; Kevin Bowrin; Jean-Baptiste Briere; Alexander Cohen; Maria Huelsebeck; Schuyler Jones; Jennifer K Quint Journal: Vasc Med Date: 2022-06-07 Impact factor: 4.739
Authors: Dennis I Narcisse; Elizabeth Hope Weissler; Jennifer A Rymer; Ehrin J Armstrong; Eric A Secemsky; William A Gray; Jihad A Mustapha; George L Adams; Gary M Ansel; Manesh R Patel; William Schuyler Jones Journal: Clin Cardiol Date: 2020-08-11 Impact factor: 2.882