Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease
Background Peripheral artery disease (PAD) is associated with heightened risk for major adverse cardiovascular and limb events, but data on the burden of risk for total (first and potentially subsequent) events, and the association with polyvascular disease, are limited. This post hoc analysis of th...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.025504 |
| _version_ | 1797810164108099584 |
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| author | Michael Szarek Connie Hess Manesh R. Patel W. Schuyler Jones Jeffrey S. Berger Iris Baumgartner Brian Katona Kenneth W. Mahaffey Lars Norgren Juuso Blomster Frank W. Rockhold Judith Hsia F. Gerry R. Fowkes Marc P. Bonaca |
| author_facet | Michael Szarek Connie Hess Manesh R. Patel W. Schuyler Jones Jeffrey S. Berger Iris Baumgartner Brian Katona Kenneth W. Mahaffey Lars Norgren Juuso Blomster Frank W. Rockhold Judith Hsia F. Gerry R. Fowkes Marc P. Bonaca |
| author_sort | Michael Szarek |
| collection | DOAJ |
| description | Background Peripheral artery disease (PAD) is associated with heightened risk for major adverse cardiovascular and limb events, but data on the burden of risk for total (first and potentially subsequent) events, and the association with polyvascular disease, are limited. This post hoc analysis of the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial evaluated total cardiovascular and limb events among patients with symptomatic PAD, overall and by number of symptomatic vascular territories. Methods and Results In the EUCLID trial, patients with symptomatic PAD (lower extremity revascularization >30 days before randomization or ankle‐brachial index ≤0.80) were randomized to treatment with ticagrelor or clopidogrel. Relative effects on total events (cardiovascular death; nonfatal myocardial infarction and ischemic stroke; acute limb ischemia, unstable angina, and transient ischemic attack requiring hospitalization; coronary, carotid, and peripheral revascularization procedures; and amputation for symptomatic PAD) were summarized by hazard ratios (HRs), whereas absolute risks were estimated by incidence rates and mean cumulative functions. Among 13 885 randomized patients, 7600 total cardiovascular and limb events occurred during a median 2.7 years of follow‐up, translating to 60.0 and 62.5 events per 100 patients through 3 years for the ticagrelor and clopidogrel groups, respectively (HR, 0.96; 95% CI, 0.89–1.03; P=0.27). Among 1393 patients with disease in 3 vascular territories, event accrual rates through 3 years for the ticagrelor and clopidogrel groups were 87.3 and 97.7 events per 100 patients, respectively. Absolute risk reductions for ticagrelor relative to clopidogrel at 3 years were −0.2, 6.7, and 10.3 events per 100 patients for 1, 2, and 3 affected vascular territories, respectively (Pinteraction=0.09). Conclusions Patients with symptomatic PAD have nearly double the number of total events than first events, with rates reflecting the number of affected vascular territories. These findings highlight the clinical relevance of quantifying disease burden in terms of total events and the need for long‐term preventive treatments in high‐risk patient populations. Registration URL: https://clinicaltrials.gov/; Unique identifier: NCT01732822. |
| first_indexed | 2024-03-13T07:05:07Z |
| format | Article |
| id | doaj.art-18699052c2634fccb3f16e04b1efee27 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T07:05:07Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-18699052c2634fccb3f16e04b1efee272023-06-06T12:11:52ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-06-01111110.1161/JAHA.122.025504Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery DiseaseMichael Szarek0Connie Hess1Manesh R. Patel2W. Schuyler Jones3Jeffrey S. Berger4Iris Baumgartner5Brian Katona6Kenneth W. Mahaffey7Lars Norgren8Juuso Blomster9Frank W. Rockhold10Judith Hsia11F. Gerry R. Fowkes12Marc P. Bonaca13CPC Clinical Research Aurora COCPC Clinical Research Aurora CODuke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCNew York University School of Medicine New York NYSwiss Cardiovascular CenterInselspitalBern University HospitalUniversity of Bern SwitzerlandAstraZeneca Gaithersburg Gaithersburg MDStanford Center for Clinical Research Stanford University School of Medicine Stanford CAFaculty of Medicine and Health Örebro University Örebro SwedenTurku University Hospital Turku FinlandDuke Clinical Research Institute Durham NCCPC Clinical Research Aurora COUsher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UKCPC Clinical Research Aurora COBackground Peripheral artery disease (PAD) is associated with heightened risk for major adverse cardiovascular and limb events, but data on the burden of risk for total (first and potentially subsequent) events, and the association with polyvascular disease, are limited. This post hoc analysis of the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial evaluated total cardiovascular and limb events among patients with symptomatic PAD, overall and by number of symptomatic vascular territories. Methods and Results In the EUCLID trial, patients with symptomatic PAD (lower extremity revascularization >30 days before randomization or ankle‐brachial index ≤0.80) were randomized to treatment with ticagrelor or clopidogrel. Relative effects on total events (cardiovascular death; nonfatal myocardial infarction and ischemic stroke; acute limb ischemia, unstable angina, and transient ischemic attack requiring hospitalization; coronary, carotid, and peripheral revascularization procedures; and amputation for symptomatic PAD) were summarized by hazard ratios (HRs), whereas absolute risks were estimated by incidence rates and mean cumulative functions. Among 13 885 randomized patients, 7600 total cardiovascular and limb events occurred during a median 2.7 years of follow‐up, translating to 60.0 and 62.5 events per 100 patients through 3 years for the ticagrelor and clopidogrel groups, respectively (HR, 0.96; 95% CI, 0.89–1.03; P=0.27). Among 1393 patients with disease in 3 vascular territories, event accrual rates through 3 years for the ticagrelor and clopidogrel groups were 87.3 and 97.7 events per 100 patients, respectively. Absolute risk reductions for ticagrelor relative to clopidogrel at 3 years were −0.2, 6.7, and 10.3 events per 100 patients for 1, 2, and 3 affected vascular territories, respectively (Pinteraction=0.09). Conclusions Patients with symptomatic PAD have nearly double the number of total events than first events, with rates reflecting the number of affected vascular territories. These findings highlight the clinical relevance of quantifying disease burden in terms of total events and the need for long‐term preventive treatments in high‐risk patient populations. Registration URL: https://clinicaltrials.gov/; Unique identifier: NCT01732822.https://www.ahajournals.org/doi/10.1161/JAHA.122.025504clopidogrelperipheral artery diseasepolyvascular diseaseticagrelortotal events |
| spellingShingle | Michael Szarek Connie Hess Manesh R. Patel W. Schuyler Jones Jeffrey S. Berger Iris Baumgartner Brian Katona Kenneth W. Mahaffey Lars Norgren Juuso Blomster Frank W. Rockhold Judith Hsia F. Gerry R. Fowkes Marc P. Bonaca Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease clopidogrel peripheral artery disease polyvascular disease ticagrelor total events |
| title | Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease |
| title_full | Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease |
| title_fullStr | Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease |
| title_full_unstemmed | Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease |
| title_short | Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease |
| title_sort | total cardiovascular and limb events and the impact of polyvascular disease in chronic symptomatic peripheral artery disease |
| topic | clopidogrel peripheral artery disease polyvascular disease ticagrelor total events |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.025504 |
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