Outcome events in patients with claudication: a 15-year study in 2777 patients.
OBJECTIVE
The purpose of this study was to delineate the natural history of claudication and determine risk factors for death.


METHODS
We reviewed the key outcomes (death, revascularization, amputation) in 2777 male patients with claudication identified over 15 years at a Veterans Administration hospital with both clinical and noninvasive criteria. Patients with rest pain or ulcers were excluded. Data were analyzed with life-table and Cox hazard models.


RESULTS
The mean follow-up was 47 months. The cohort exhibited a mortality rate of 12% per year, which was significantly (P <.05) more than the age-adjusted US male population. Among the deaths in which the cause was known, 66% were due to heart disease. We examined several baseline risk factors in a multivariate Cox model. Four were significant (P <.01) independent predictors of death: older age (relative risk [RR] = 1.3 per decade), lower ankle-brachial index (RR = 1.2 for 0.2 change), diabetes requiring medication (RR = 1.4), and stroke (RR = 1.4). The model can be used to estimate the mortality rate for specific patients. Surprisingly, a history of angina and myocardial infarction was not a significant predictor. Major and minor amputations had a 10-year cumulative rate less than 10%. Revascularization procedures occurred with a 10-year cumulative rate of 18%.


CONCLUSIONS
We found a high mortality rate in this large cohort and four independent risk factors that have a large impact on survival. Risk stratification with our model may be useful in determining an overall therapeutic plan for claudicants. A history of angina and myocardial infarction was not a useful predictor of death, suggesting that many patients in our cohort presented with claudication before having coronary artery symptoms. Our data also indicate that claudicants have a low risk of major amputation at 10-year follow-up.
Muluk
S C
SC
Division of Vascular Surgery and the Division of General Internal Medicine, University of Pittsburgh Medical Center and Veterans Administration Medical Center, USA. muluk@usa.net
Muluk
V S
VS
Kelley
M E
ME
Whittle
J C
JC
Tierney
J A
JA
Webster
M W
MW
Makaroun
M S
MS
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000401:mortality* / Q000628:therapy; D007866:Leg / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures