Long-Term Outcomes and Associations With Major Adverse Limb Events After Peripheral Artery Revascularization

Hess, Connie N.; Wang, Tracy Y.; Fu, Julia Weleski; Gundrum, Jacob D.; LaPointe, Nancy M. Allen; Rogers, R. Kevin; Hiatt, William R.

doi:10.1016/j.jacc.2019.11.050

Cited by 59 publications

(39 citation statements)

References 26 publications

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“…18 These therapies have proven benefit and are often underprescribed in the PAD population. 19,20 Of the patients with CKD in our study, 78.6%…”

Section: Discussionmentioning

confidence: 75%

“…These patients may benefit more from aggressive medical management with high‐intensity statins and/or PCSK9 inhibitors, more aggressive control of diabetes mellitus with GLP‐1 and/or SGLT2 inhibitors, and more aggressive antiplatelet or antithrombotic medications (including rivaroxaban as demonstrated in the COMPASS trial) 18 . These therapies have proven benefit and are often underprescribed in the PAD population 19,20 . Of the patients with CKD in our study, 78.6% were on aspirin, 82.5% on lipid lowering therapy, 69.0% on clopidogrel, and 65.3% on dual antiplatelet therapy post index procedure.…”

Section: Discussionmentioning

confidence: 81%

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The impact of chronic kidney disease on outcomes following peripheral vascular intervention

Narcisse

Weissler

Rymer

et al. 2020

Clinical Cardiology

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Background: Patients with chronic kidney disease (CKD) have worsened clinical outcomes following percutaneous coronary intervention; however, limited evidence exists in patients undergoing peripheral vascular intervention (PVI). Purpose: We aimed to assess the effect of CKD on outcomes following PVI for symptomatic peripheral artery disease. Methods: Using patients from the LIBERTY 360 study, we compared the rates of 30 day and 1 year major adverse vascular events (MAVE), a composite of all-cause mortality, major amputation, and target vessel/lesion revascularization, between patients with and without CKD (estimated glomular filtration rate less than 60) following PVI. Multivariable adjustment was performed to assess for independent association between CKD and outcomes. Results: Among 1189 patients enrolled, 378 patients (31.8%) had CKD. At 1 year, patients with CKD had higher rates of MAVE (34.6% vs 25.6%), all-cause mortality (11.9% vs 5.5%), and major amputation (5.9% vs 2.6%) when compared with patients without CKD (all P < .05). After adjustment, patients with CKD had higher risks of 1-year MAVE (HR 1.30, 95% CI 1.04-1.64; P = .023) and all-cause mortality (HR 1.88, 95% CI 1.22-2.91; P = .005) when compared with patients without CKD. There was no statistically significant difference in risk of major amputations (HR 1.70, 95% CI 0.91-3.17; P = .094). Conclusions: Despite high procedural success and low amputation rates, patients with CKD remain at greater risk for MAVE and all-cause mortality after PVI. Further research is needed to determine treatment strategies to mitigate substantial mortality risk in this vulnerable population.

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“…18 These therapies have proven benefit and are often underprescribed in the PAD population. 19,20 Of the patients with CKD in our study, 78.6%…”

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 81%

The impact of chronic kidney disease on outcomes following peripheral vascular intervention

Narcisse

Weissler

Rymer

et al. 2020

Clinical Cardiology

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“…These findings are corroborated by a recent study of US hospital discharge billing files conducted by Hess et al, which found that 12.9% of patients who underwent revascularization experienced a subsequent MALE, defined as a hospitalization for ALI, major limb amputation, or surgical peripheral revascularization. 15 Additionally, the study reported comparable, but lower incidence rates of major amputation (1.11-6.08/100 patient years), MI (1.32-1.40/100 patient years), and stroke (0.69-0.83/100 patient years) after revascularization. Of note, it is important to distinguish the different study design elements used by Hess et al, including limiting the outcomes to events occurring during inpatient and hospital-based outpatient visits, the definition of the MALE composite outcome, and the inclusion of patients covered under any type of insurance, which likely contributed to the differences in findings between the two studies.…”

Section: Discussionmentioning

confidence: 76%

“…A recent study by Hess C and colleagues, using US hospital discharge billing files, reported that 12.9% of patients with PAD who underwent lower extremity revascularization experienced a subsequent major adverse limb events (MALE). 15 Another recent claims-based, real-world study among patients with chronic PAD conducted by Berger et al characterized the incidence rates of major adverse cardiovascular events (MACE) and MALE associated with PAD. 8 The incidence of MACE was estimated to be 5.32/100 person years, while the incidence of MALE was 7.44/100 person years, producing a combined MACE or MALE incidence rate of 12.16/100 person years.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Major Atherothrombotic Vascular Events among Patients with Peripheral Artery Disease after Revascularization

Desai

Kharat

Hess³

et al. 2021

Annals of Vascular Surgery

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Background: Patients with peripheral artery disease (PAD) treated with lower extremity revascularization are at increased risk of major atherothrombotic vascular events (acute limb ischemia (ALI), major non-traumatic lower-limb amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular (CV)-related death). This study assessed the incidence of major atherothrombotic vascular events, venous thromboembolism (VTE) events and rates of subsequent lower extremity revascularizations in the real-world among patients with PAD after revascularization. Methods: Patients aged ≥50 years with PAD who underwent peripheral revascularization were identified from Optum Clinformatics Data Mart claims database (Q1/2014-Q2/2019). The first lower extremity revascularization after PAD diagnosis was defined as index date. Incidence rates of major atherothrombotic vascular events (i.e., composite of ALI, major non-traumatic lower-limb amputation, MI, ischemic stroke, and CV-related death) and VTE were assessed during followup as the number of events divided by patient-years of observation (censored at the first event). Rates of subsequent revascularizations and VTE were estimated overall and compared between patients with major atherothrombotic vascular events and those without. Results: Of the 38,439 patients included, 6,675 (17.4%) had a major atherothrombotic vascular event during a median follow-up of 1.0 year. The composite major atherothrombotic vascular and VTE incidence rates were 13.81/100 patient years and 1.77/100 patient years, respectively, and 40.2% of patients experienced subsequent revascularizations. Patients with a post-revascularization major atherothrombotic vascular event had significantly higher rates of subsequent revascularizations (64.6% vs. 35.1%, standardized difference [SD] ≥10%) and VTE (4.6% vs. 2.1%, SD ≥10%) versus those without. Conclusion: One-in-six PAD patients aged ≥50 years who underwent peripheral revascularization experienced a major atherothrombotic vascular event within one year, and consequently, experienced higher rates of subsequent revascularizations compared with those without a major atherothrombotic vascular event post-revascularization. These findings highlight the need to improve strategies to prevent major atherothrombotic vascular events after revascularization.

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“…As PAD progresses, endovascular or surgical revascularization procedures may be required to improve symptoms and prevent tissue loss in severe cases [4], which in turn could improve patients' quality of life [9,10]. Despite improvements in clinical management for PAD, evidence suggests that patients undergoing revascularization may face increased risk of major atherothrombotic vascular events after the procedure, specifically ALI, MI, amputation, ischemic stroke, and CV-related death [11][12][13][14][15][16]. For example, in a post hoc analysis of the EUCLID randomized trial for treatment for PAD, patients enrolled based on previous revascularization had four times the risk of ALI and a 29% increased risk of MI compared to those enrolled based on other diagnostic metrics (all p<0.01) [12].…”

Section: Introductionmentioning

confidence: 99%

Healthcare resource utilization and costs of major atherothrombotic vascular events among patients with peripheral artery disease after revascularization

Desai

Kharat

Hess

et al. 2021

Journal of Medical Economics

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Peripheral artery disease (PAD), often treated with lower extremity revascularization, is associated with risk of major atherothrombotic vascular events (acute limb ischemia [ALI], major non-traumatic lower-limb amputation, myocardial infarction [MI], ischemic stroke, cardiovascular death). This study aims to assess healthcare resource utilization and costs of such events among patients with PAD after revascularization. MATERIALS AND METHODS: Patients aged ≥50 years with PAD who were treated with lowerextremity revascularization were identified from Optum Clinformatics Data Mart claims database (01/2014-06/2019). The first lower extremity revascularization after PAD diagnosis was defined as the index date. Patients had ≥6 months of health plan enrollment before the index date. Patients were followed until the earliest of 1) end of enrollment or data; 2) diagnosis of atrial fibrillation or venous thromboembolism; or 3) oral anticoagulant use. Allcause healthcare resource use per-patient-year was compared before and after a major atherothrombotic vascular event post-revascularization among those with an event. Additionally, event-related healthcare costs per-patient-year were reported for each event type. RESULTS: Of the 38,439 PAD patients meeting the study criteria, 6,675 (17.4%) had a major atherothrombotic vascular event. On average, patients were observed for 7.3 months before an event and 6.2 months after an event. Patients with an event had significantly higher all-cause healthcare resource use versus similar metrics pre-event (e.g., inpatient visits among those with

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Long-Term Outcomes and Associations With Major Adverse Limb Events After Peripheral Artery Revascularization

Cited by 59 publications

References 26 publications

The impact of chronic kidney disease on outcomes following peripheral vascular intervention

The impact of chronic kidney disease on outcomes following peripheral vascular intervention

Incidence of Major Atherothrombotic Vascular Events among Patients with Peripheral Artery Disease after Revascularization

Healthcare resource utilization and costs of major atherothrombotic vascular events among patients with peripheral artery disease after revascularization

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