Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis
Background We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (...
| Main Authors: | , , , , , , , , , , , , |
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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.121.024279 |
| _version_ | 1797301691922513920 |
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| author | E. Hope Weissler Yongfei Wang Jordan M. Gales Dmitriy N. Feldman Shipra Arya Eric A. Secemsky Herbert D. Aronow Beau M. Hawkins J. Antonio Gutierrez Manesh R. Patel Jeptha P. Curtis W. Schuyler Jones Rajesh V. Swaminathan |
| author_facet | E. Hope Weissler Yongfei Wang Jordan M. Gales Dmitriy N. Feldman Shipra Arya Eric A. Secemsky Herbert D. Aronow Beau M. Hawkins J. Antonio Gutierrez Manesh R. Patel Jeptha P. Curtis W. Schuyler Jones Rajesh V. Swaminathan |
| author_sort | E. Hope Weissler |
| collection | DOAJ |
| description | Background We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (CLTI). Methods and Results Patients undergoing PVI in the American College of Cardiology’s (ACC) National Cardiovascular Data Registry’s PVI Registry who could be linked to Centers for Medicare and Medicaid Services data were included. The primary outcomes were MACE, MALE, and readmission within 1 month and 1 year following index CLTI‐PVI or non‐CLTI‐PVI. Cox proportional hazards regression was used to identify factors associated with the development of the primary outcomes among patients undergoing CLTI‐PVI. There were 1758 (49.7%) patients undergoing CLTI‐PVI and 1779 (50.3%) undergoing non‐CLTI‐PVI. By 1 year, MACE occurred in 29.5% of patients with CLTI (n=519), and MALE occurred in 34.0% of patients with CLTI (n=598). By 1 year, MACE occurred in 8.2% of patients with non‐CLTI (n=146), and MALE occurred in 26.1% of patients with non‐CLTI (n=465). Predictors of MACE at 1 year in CLTI‐PVI included end‐stage renal disease on hemodialysis, congestive heart failure, prior CABG, and severe lung disease. Predictors of MALE at 1 year in CLTI‐PVI included treatment of a prior bypass graft, profunda femoral artery treatment, end‐stage renal disease on hemodialysis, and treatment of a previously treated lesion. Conclusions Patients ≥65 years old undergoing PVI experience high rates of MACE and MALE. A range of modifiable and non‐modifiable patient factors, procedural characteristics, and medications are associated with the occurrence of MACE and MALE following CLTI‐PVI. |
| first_indexed | 2024-03-07T23:26:15Z |
| format | Article |
| id | doaj.art-efacbf56fbe0441ba8ad302a5ef23f24 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:26:15Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-efacbf56fbe0441ba8ad302a5ef23f242024-02-21T04:31:45ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-06-01111210.1161/JAHA.121.024279Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry AnalysisE. Hope Weissler0Yongfei Wang1Jordan M. Gales2Dmitriy N. Feldman3Shipra Arya4Eric A. Secemsky5Herbert D. Aronow6Beau M. Hawkins7J. Antonio Gutierrez8Manesh R. Patel9Jeptha P. Curtis10W. Schuyler Jones11Rajesh V. Swaminathan12Division of Vascular and Endovascular Surgery Department of Surgery Duke University School of Medicine Durham NCSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTTexas Heart Institute Houston TXDivision of Cardiology Weill Cornell Medical College New York NYDivision of Vascular and Endovascular Surgery Stanford University School of Medicine Palo Alto CADivision of Cardiology Beth Israel Deaconess Medical Center Boston MALifespan Cardiovascular Institute/Alpert Medical School at Brown University Providence RICardiovascular Section University of Oklahoma Health Sciences Center Oklahoma OKDivision of Cardiology Duke University Health System Durham NCDivision of Cardiology Duke University Health System Durham NCSection of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CTDivision of Cardiology Duke University Health System Durham NCDivision of Cardiology Duke University Health System Durham NCBackground We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (CLTI). Methods and Results Patients undergoing PVI in the American College of Cardiology’s (ACC) National Cardiovascular Data Registry’s PVI Registry who could be linked to Centers for Medicare and Medicaid Services data were included. The primary outcomes were MACE, MALE, and readmission within 1 month and 1 year following index CLTI‐PVI or non‐CLTI‐PVI. Cox proportional hazards regression was used to identify factors associated with the development of the primary outcomes among patients undergoing CLTI‐PVI. There were 1758 (49.7%) patients undergoing CLTI‐PVI and 1779 (50.3%) undergoing non‐CLTI‐PVI. By 1 year, MACE occurred in 29.5% of patients with CLTI (n=519), and MALE occurred in 34.0% of patients with CLTI (n=598). By 1 year, MACE occurred in 8.2% of patients with non‐CLTI (n=146), and MALE occurred in 26.1% of patients with non‐CLTI (n=465). Predictors of MACE at 1 year in CLTI‐PVI included end‐stage renal disease on hemodialysis, congestive heart failure, prior CABG, and severe lung disease. Predictors of MALE at 1 year in CLTI‐PVI included treatment of a prior bypass graft, profunda femoral artery treatment, end‐stage renal disease on hemodialysis, and treatment of a previously treated lesion. Conclusions Patients ≥65 years old undergoing PVI experience high rates of MACE and MALE. A range of modifiable and non‐modifiable patient factors, procedural characteristics, and medications are associated with the occurrence of MACE and MALE following CLTI‐PVI.https://www.ahajournals.org/doi/10.1161/JAHA.121.024279chronic limb‐threatening ischemiaendovascular revascularizationlower extremity revascularizationperipheral artery diseaseperipheral vascular intervention |
| spellingShingle | E. Hope Weissler Yongfei Wang Jordan M. Gales Dmitriy N. Feldman Shipra Arya Eric A. Secemsky Herbert D. Aronow Beau M. Hawkins J. Antonio Gutierrez Manesh R. Patel Jeptha P. Curtis W. Schuyler Jones Rajesh V. Swaminathan Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic limb‐threatening ischemia endovascular revascularization lower extremity revascularization peripheral artery disease peripheral vascular intervention |
| title | Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis |
| title_full | Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis |
| title_fullStr | Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis |
| title_full_unstemmed | Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis |
| title_short | Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis |
| title_sort | cardiovascular and limb events following endovascular revascularization among patients ≥65 years old an american college of cardiology pvi registry analysis |
| topic | chronic limb‐threatening ischemia endovascular revascularization lower extremity revascularization peripheral artery disease peripheral vascular intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024279 |
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