Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis

Weissler, E. Hope; Wang, Yongfei; Gales, Jordan M; Feldman, Dmitriy N.; Arya, Shipra; Secemsky, Eric A.; Aronow, Herbert D.; Hawkins, Beau M.; Gutiérrez, Jorge; Patel, Manesh R.; Curtis, Jeptha P.; Jones, W. Schuyler; Swaminathan, Rajesh V.

doi:10.1161/jaha.121.024279

Cited by 14 publications

(8 citation statements)

References 33 publications

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“…[35][36][37] This includes cohorts undergoing peripheral vascular intervention, despite data demonstrating an increased risk of MALE in individuals who have not been prescribed statin and antiplatelet therapy following revascularization. 25 Although no differences in cardiovascular medication use were observed between groups in our current study, the overall low frequency of key medications including statin and antiplatelet agents is concerning and may disproportionately affect PLWH due to their higher burden of cardiovascular comorbidities. Further attention is needed to maximize optimal medical therapy, treat uncontrolled comorbidities, and intervene on tobacco utilization if long-term PVI outcomes are going to be comparable to the general population.…”

Section: Discussioncontrasting

confidence: 63%

Longitudinal outcomes following peripheral vascular intervention among older persons living with HIV

Kentoffio,

Sun,

et al. 2023

Vasc Med

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Background: Persons living with human immunodeficiency virus (HIV, PLWH) have an increased risk of peripheral artery disease (PAD) in comparison to the general population. However, a gap remains in understanding optimal management for this condition. This study assesses longitudinal outcomes associated with peripheral endovascular intervention (PVI) for PAD among PLWH. Methods: All Medicare fee-for-service patients undergoing femoropopliteal artery PVI between April 1, 2015 and December 31, 2018 were identified and stratified by HIV serostatus. The primary outcome was major adverse limb events (MALE), defined as major amputation or arterial embolism/thrombosis following an index procedure. The subdistribution hazard was used to evaluate the association between HIV serostatus and MALE, accounting for the competing risk of death. Results were adjusted for sociodemographics and major comorbidities. Results: Of 168,553 patients who underwent PVI, 357 (0.21%) were PLWH. The average age was 77.0 ± 7.6 years; 80.3% had hypertension, 70.3% had hyperlipidemia, and 24.6% had tobacco use disorder. Compared to those without HIV, PLWH were younger and had a higher burden of cardiovascular risk factors. MALE were substantially more frequent among PLWH, with a cumulative incidence of 24.6%, compared to 14.5% among those without HIV. The adjusted subdistribution hazard ratio was 1.26 (95% CI 1.00–1.58, p = 0.05). The use of guideline-directed statin therapy was low in both groups in the 90 days following revascularization (57.9% in PLWH vs 58.1% in those without HIV, p = 0.95). Conclusion: Among US Medicare beneficiaries, PLWH had poorer long-term outcomes following PVI. Greater attention to the management of symptomatic PAD is warranted for the HIV population, particularly following revascularization.

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Section: Discussioncontrasting

confidence: 63%

Longitudinal outcomes following peripheral vascular intervention among older persons living with HIV

Kentoffio,

Sun,

et al. 2023

Vasc Med

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“…Recently published health claims-based data underscored a substantial risk of MALE after EVR, with a rate of hospitalization for MALE of 12.9% in 400.000 patients who underwent EVR of PAD in the US (median follow-up: 2.7 years) [ 3 ]. CLTI and advanced age, both somewhat more common in the registry compared to the RCT, have been shown to be negatively associated with extremity outcomes (e.g., amputation free survival) in PAD cohorts [ 12 , 13 , 14 , 15 ]. The same is true for advanced chronic kidney disease, which was three times more common in the registry, although absolute numbers were low [ 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics in the Recording Courses of Vascular Diseases (Reccord) Registry: Comparison with the Voyager Pad Endovascular Cohort

Czihal

Malyar

Stausberg

et al. 2023

JCDD

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Background: To compare the characteristics of a “real world” population included in a prospective registry to patients enrolled in a randomized, controlled trial (RCT) after endovascular revascularization (EVR) for symptomatic peripheral artery disease (PAD). Methods: The RECcording COurses of vasculaR Diseases (RECCORD) registry is an observational registry prospectively recruiting patients undergoing EVR for symptomatic PAD in Germany. VOYAGER PAD was an RCT which demonstrated the superiority of rivaroxaban and aspirin versus aspirin to reduce major cardiac and ischemic limb events following infrainguinal revascularization for symptomatic PAD. For this exploratory analysis, the clinical characteristics of 2.498 patients enrolled in RECCORD and of 4.293 patients from VOYAGER PAD who underwent EVR were compared. Results: The rate of patients aged ≥ 75 years was considerably higher in the registry (37.7 vs. 22.5%). More patients in the registry had undergone previous EVR (50.7 vs. 38.7%) or suffered from critical limb threatening ischemia (24.3 vs. 19.5%). Registry patients were more commonly active smokers (51.8 vs. 33.6%), but less frequently suffered from diabetes mellitus (36.4 vs. 44.7%). While statins (70.5 vs. 81.7%) were less frequently used, antiproliferative catheter technologies (45.6 vs. 31.4%) and postinterventional dual antiplatelet therapy (64.5 vs. 53.6%) were more commonly applied in the registry. Conclusions: There were many similarities but some clinically meaningful differences in clinical characteristics between PAD patients who underwent EVR and were included in a nationwide registry and PAD patients from the VOYAGER PAD trial.

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“…As a sign of PAD, intermittent claudication is prevalent, and if these symptoms worsen, they can lead to gangrene or limb-threatening infections, known as CLI. Approximately 40 percent of diabetic patients develop necrosis and gangrene as a result of CLI, compared to only 9% of non-diabetics [19,20].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Angiographic Characteristics of Peripheral Arterial Disease between Diabetic and Non-Diabetics

Ullah¹,

Ullah²,

Ahmad³

et al. 2022

PJMHS

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Background and Aim: Several factors contribute to the poor outcomes of peripheral arterial disease (PAD). The current study examined the results of peripheral transluminal angioplasty (PTA) in diabetics and non-diabetics with peripheral arterial disease (PAD). Patients and Methods: This cross-sectional study was carried out on 136 peripheral arteries disease patients including 84 non-diabetic and 52 diabetics in the department of Cardiology, Hayatabad Medical Complex, Peshawar during the period from January 2022 to June 2022. This study included patients with PADs who had PTAs performed on their femoral, iliac, infrapopliteal, and popliteal arteries. Study protocol was approved by the research and ethical committee. Patient’s demographic details and medical history were recorded. SPSS version 26 was used for data analysis. Results: The overall mean age was 64.6 ± 10.51 years. Diabetic patients were compared with non-diabetic patients in terms of age (63.8±11.2 versus 65.4± 9.82 years), smoking history (80.7% vs. 46.4%), hypercholesterolemia (25.4% versus 31.9%), and ischemic heart disease (40.6% versus 36.5%). The frequency of hypertensive patients was higher 64.8% in diabetic patients against 40.6% in non-diabetic patients. In terms of arterial segment below the knee and profunda femoris, arterial disease had higher severity in diabetic patients. Diabetic patients were more susceptible to amputation (43.2% vs. 12%, OR=4.8, P=0.001) and had higher mortality (48.9% versus 23.8%). Conclusion: The present study found that higher prevalence of limb ischemia, amputation, and higher rates of restenosis following peripheral transluminal angioplasty was found in diabetic patients compared to non-diabetic patients. Diabetic patients had poor prognosis and worse arterial disease than non-diabetic patients. Keywords: Diabetic patients, Angiographic characteristics, Peripheral arteries disease.

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Cardiovascular and Limb Events Following Endovascular Revascularization Among Patients ≥65 Years Old: An American College of Cardiology PVI Registry Analysis

Cited by 14 publications

References 33 publications

Longitudinal outcomes following peripheral vascular intervention among older persons living with HIV

Longitudinal outcomes following peripheral vascular intervention among older persons living with HIV

Patient Characteristics in the Recording Courses of Vascular Diseases (Reccord) Registry: Comparison with the Voyager Pad Endovascular Cohort

Comparison of Angiographic Characteristics of Peripheral Arterial Disease between Diabetic and Non-Diabetics

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