Paclitaxel and Mortality in Patients With Claudication and De Novo Femoropopliteal Lesions: A Historical Cohort Study

Abstract

Objective: To compare the mortality rates of patients with claudication and de novo femoropopliteal lesions treated with and without paclitaxel coated devices (PCD).Background: A recent meta-analysis, mostly including patients with claudication and de novo femoropopliteal lesions but also with recurrent stenoses and critical limb ischemia, has shown a significant excess mortality in patients treated with PCD.Methods: Comparison of two historical cohorts of patients presenting with claudication and de novo femoropopliteal lesions treated with and without PCD at our institution between 2008 and 2018.Results: After review of 5219 arteriograms in patients presenting with peripheral artery disease, 700 consecutive patients were included consisting in 72.6% of male (n=508). Mean age was 68.1±8.5 years. 45.7% of the patients (n=320) had a treatment including a PCD. Mean femoropopliteal lesion length was 123±91mm including 44.6% of occlusions. Patients of the control group were censored at crossover to paclitaxel when applicable. Mortality rates at 1, 2 and 5 years were 4.6%, 7.5%, 19.4% and 1.6%, 6.2%, 16.6% in the non-PCD and PCD groups respectively. The relative risks of death when using PCD were 0.35 (p=0.03), 0.83 (p= NS) and 0.86 (p= NS) at 1, 2 and 5 years respectively. Conclusion: There was no excess mortality in patients with claudication and de novo femoropopliteal lesions treated with paclitaxel coated devices at 1, 2 and 5 years of follow-up. The current study suggests that additional prospective randomized studies properly powered to study mortality are necessary.