Predictors of mortality in patients with lower extremity peripheral arterial disease: 5-year follow-up.
BACKGROUND
Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long-term survival benefits of LE arterial revascularization.


METHODS
Two hundred and eighty-three patients with an ankle brachial index (ABI) <or=0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all-cause mortality were measured at 5 years.


RESULTS
Of 283 patients identified, 42 (15%) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26%) patients underwent repeat procedures over the 5 years of follow-up. Those undergoing revascularization were more often Caucasian (95% vs. 79%, P = 0.01) and had lower ABIs (ABI <or= 0.4, 45% vs. 17%, P = <0.001). At 44 +/- 19 months follow-up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24%) versus 107/241 (44%) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all-cause mortality (HR 0.51 [95% CI 0.26-1.02], P = 0.056). Independent predictors of mortality were age >or=65 years (HR 2.42 [95% CI 1.52-3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95% CI 1.13-2.46], P = 0.010), chronic kidney disease (HR 1.75 [95% CI 1.15-2.67], P = 0.010), and an ABI <or= 0.4 (HR 1.88 [95% CI 1.19-2.96], P = 0.006).


CONCLUSIONS
Few patients at this center with LE-PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5-year mortality in those undergoing LE arterial revascularization when compared to those who do not.
Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana, USA. zjaffery@ochsner.org
Zehra
Z
Jaffery
Adam B
AB
Greenbaum
Mohammad F
MF
Siddiqui
Neetu
N
Mahendraker
Vikesh
V
Gupta
Vidu
V
Mokkala
Uday
U
Kanakadandi
Andrew
A
Robbins
James
J
McCord
D000368:Aged; D055109:Ankle Brachial Index; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007866:Leg / Q000098:blood supply* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors