Impact of betablockers on general and local outcome in patients hospitalized for lower extremity peripheral artery disease: The COPART Registry.
Lower extremity peripheral artery disease (PAD) is one manifestation of atherosclerosis. Patients with PAD have an increased rate of mortality due to concurrent coronary artery disease and hypertension. Betablockers (BB) may, therefore, be prescribed, especially in case of heart failure. However, BB safety in PAD is controversial, because of presumed peripheral hemodynamic consequences of BB that could lead to worsening of symptoms in patients with PAD. In this context, we aimed to determine the impact of BB on all-cause and cardiovascular mortality and amputation rate at 1 year after hospitalization for PAD from the COPART Registry population. This is a prospective multicenter observational study collecting data from consecutive patients hospitalized for PAD in vascular medicine departments of 4 academic hospitals in France. Patients with, either claudication, critical limb ischemia or acute lower limb ischemia related to a documented PAD were included. We compared the outcomes of patients with BB versus those without BB in their prescription list at hospital discharge. The mean age of the study population was 70.9 years, predominantly composed of males (71%). Among the 1267 patients at admission, 28% were treated by BB for hypertension, prior myocardial infarction or heart failure. During their hospital stay, 40% underwent revascularization (including bypass surgery 29% and angioplasty 74%), 17% required an amputation, and 5% died. In a multivariate analysis, only prior myocardial infarction was found associated with BB prescription with an odds ratio (OR) of 3.11, P < 0.001. Conversely, chronic obstructive pulmonary disease or PAD with ulcer impeded BB prescription (OR: 0.57 and 0.64, P = 0.007; P = 0.001, respectively). One-year overall mortality of patients with BB did not differ from those without (23% vs. 23%, P = 0.95). The 1-year amputation rate did not differ either (4% vs. 6%, P = 0.14). Patients hospitalized for PAD with a BB in their prescription did not worsen their outcome at 1 year compared to patients without BB. Based on these safety data, prospective study could be conducted to assess the effect of BB on long-term mortality and amputation rate in patients with mild, moderate, and severe PAD.
Department of Vascular Medicine, Hôpital européen Georges-Pompidou, assistance publique hôpitaux de Paris, APHP, Paris Descartes University, Sorbonne Paris Cite, PARCC, INSERM U970, Paris Department of Vascular Medicine, Rangueil Hospital, Institute of Molecular Medicine of Rangueil, INSERM U858 Department of Biostatistics, Rangueil Hospital, Toulouse Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges Department of Cardiology, Dupuytren University Hospital, INSERM U1094, Limoges Department of Vascular Medicine, Saint-André Hospital, Bordeaux, France.
Tristan
T
Mirault
Alexandre
A
Galloula
Jean-Pierre
JP
Cambou
Philippe
P
Lacroix
Victor
V
Aboyans
Carine
C
Boulon
Joel
J
Constans
Alessandra
A
Bura-Riviere
Emmanuel
E
Messas
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006333:Heart Failure / Q000188:drug therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007383:Intermittent Claudication / Q000401:mortality / Q000601:surgery; D007511:Ischemia / Q000401:mortality / Q000601:surgery; D007902:Length of Stay; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D009204:Myocardial Revascularization; D058729:Peripheral Arterial Disease / Q000401:mortality* / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment
D000319:Adrenergic beta-Antagonists