title: Long-term mortality after invasive diagnostic and endovascular revascularization in PAD patients.
abstract: BACKGROUND
  The aim of this study was to assess the long-term, all-cause mortality among PAD patients hospitalized for invasive diagnostics and/or endovascular revascularization (ER) and the applied secondary prevention management.
  
  
  METHODS
  From 2005 to 2009, at our center 582 consecutive patients underwent invasive peripheral angiography in part in combination with coronary angiography and/or ER. Patients were classified according to their Fontaine stage into 3 subgroups: Fontaine I/IIa, Fontaine IIb, and Fontaine stages III and IV (which were classified as critical limb ischemia, CLI). Demographic and clinical data were retrospectively obtained and patients followed up.
  
  
  RESULTS
  Mean age increased with higher Fontaine stages (P=0.009). The proportion of patients with diabetes and anemia was lowest in Fontaine stage IIb and highest in CLI (each p<0.001). The cumulative all-cause mortality during follow-up was 17% in Fontaine stage I/IIa, 22% in Fontaine stage IIb and 34% in CLI, respectively (P<0.001). In multivariate cox regression models including diabetes mellitus, gender, age, creatinine and baseline hemoglobin, patients with Fontaine stage IIb had a 1.4-fold (95%CI 0.60-3.16) and those with CLI a 2.3-fold (95%CI 1.03-5.08) increased mortality compared to Fontaine stage I/IIa. At baseline, patients with CLI received significantly less beta blocker, statins, ACE or AT1 inhibitors and less anticoagulants; at follow-up only statins were significantly less often prescribed to CLI patients (all p<0.05). Univariate analyses showed that a therapy with statins (HR 0.64; CI 0.43-0.96; P=0.03) and antiplatelet/anticoagulant agents (HR 0.5; CI 0.27-0.94; P=0.03) significantly reduced mortality.
  
  
  CONCLUSIONS
  Long-term mortality in CLI patients doubles the rate in patients with Fontaine stage I/IIa. Non-adherence to evidence-based recommendations and guidelines such as inadequate use of cardioprotective drugs might contribute to the observed high mortality rates in patients with CLI.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University of Muenster, Muenster, Germany - e.bro@me.com.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Broich
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Malyar
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyborg
authors.forename: Katrin
authors.initials: K
authors.lastname: Gebauer
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016638:Critical Illness; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents