Fate of individuals with ischemic amputations in the REACH Registry: three-year cardiovascular and limb-related outcomes.
OBJECTIVE
To evaluate systemic and limb ischemic event rates of PAD patients with prior leg amputation and determine predictors of adverse outcomes.


METHODS
The REduction of Atherothrombosis for Continued Health (REACH) Registry provided a prospective multinational cohort of 7996 outpatients with PAD enrolled from primary medical clinics in 44 countries in 2003-2004. 1160 patients (14.5%) had a prior leg amputation at any level. Systemic (myocardial infarction [MI], stroke, cardiovascular death) and limb (angioplasty, surgery, amputation) ischemic event rates were determined in a 3-year follow-up.


RESULTS
PAD patients with leg amputations on entry had a 5-fold higher rate of a subsequent amputation (12.4% vs. 2.4%, P<.001), lower rate of peripheral angioplasty (8.3% vs. 10.7%, P = .005), and similar rates of surgical revascularization procedures compared with PAD patients without amputation. A nearly 2-fold increase in rates of cardiovascular death (14.5% vs. 7.7%, P<.001) and all-cause mortality (21.8% vs. 12.6%, P<.001) and an increase in the composite outcome of MI, stroke, cardiovascular death, or hospitalization (48.7% vs. 40.0%, P<.001) were noted. Recent (≤ 1 year) amputation was associated with higher rates of worsening PAD, subsequent lower extremity surgical revascularization procedures, re-amputation, non-fatal MI, and the composite outcome, including hospitalization. Adverse systemic and limb ischemic outcomes were similar regardless of amputation level.


CONCLUSIONS
Individuals with a history of leg amputations have markedly elevated rates of systemic and limb-related outcomes. PAD patients with recent ischemic amputation have the highest risk of adverse events. A history of "minor" ischemic amputation may confer an identical systemic risk as "major" leg amputation.
Division of Education, Philippine Heart Center, Quezon City, Philippines. tesabola@mac.com
Maria Teresa B
MT
Abola
Deepak L
DL
Bhatt
Sue
S
Duval
Patrice P
PP
Cacoub
Iris
I
Baumgartner
Hong
H
Keo
Mark A
MA
Creager
Danielle M
DM
Brennan
Ph Gabriel
PG
Steg
Alan T
AT
Hirsch
D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006760:Hospitalization; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome