Effects of successful percutaneous lower extremity revascularization on cardiovascular outcome in patients with peripheral arterial disease.
BACKGROUND
Lower extremity peripheral arterial disease (LE-PAD) reduces walking capacity and is associated with an increased cardiovascular risk. Endovascular revascularization of LE-PAD improves walking performance and quality of life. In the present study, we determined whether successful lower limbs revascularization also impacts cardiovascular outcome in LE-PAD patients.


METHODS
479 consecutive LE-PAD patients at stage II of Fontaine's classification, with ankle/brachial index ≤ 0.90 and one or more stenosis >50% in at least one leg artery, were enrolled in the study. According to the Trans-Atlantic Inter Society Consensus II recommendations, 264 (55.1%) underwent percutaneous lower extremity angioplasty (PTA group), while 215 (44.9%) were managed with conservative therapy (MT group). The incidence of major cardiovascular events (including cardiovascular death, myocardial infarction, ischemic stroke, coronary and carotid revascularizations) was prospectively analyzed by Kaplan-Meier curves. Crude and adjusted HRs (95% CI) of developing a cardiovascular event were calculated by Cox analysis.


RESULTS
No baseline differences were observed among the groups, except for a lower maximum walking distance in the PTA group. During a median follow-up of 21 months (12.0-29.0), the incidence of cardiovascular events was markedly lower in PTA compared to MT patients (6.4% vs. 16.3%; p=0.003), and patients in the MT group showed a 4.1-fold increased cardiovascular risk compared to patients in the PTA group, after adjustment for potential confounders (95% CI 1.22-13.57, p=0.023).


CONCLUSIONS
This study shows that successful revascularization of LE-PAD patients affected by intermittent claudication, in addition to improving functional status, reduces the occurrence of future major cardiovascular events.
Division of Cardiology, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy.
Giuseppe
G
Giugliano
Luigi
L
Di Serafino
Cinzia
C
Perrino
Vittorio
V
Schiano
Eugenio
E
Laurenzano
Salvatore
S
Cassese
Mario
M
De Laurentis
Gabriele Giacomo
GG
Schiattarella
Linda
L
Brevetti
Anna
A
Sannino
Giuseppe
G
Gargiulo
Anna
A
Franzone
Ciro
C
Indolfi
Federico
F
Piscione
Bruno
B
Trimarco
Giovanni
G
Esposito
D000368:Aged; D017130:Angioplasty / Q000379:methods*; D055109:Ankle Brachial Index / Q000379:methods; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome