Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis

Malyar, Nasser; Fürstenberg, Torsten; Wellmann, Jürgen; Meyborg, Matthias; Lüders, Florian; Gebauer, Katrin; Bunzemeier, Holger; Roeder, N.; Reinecke, Holger

doi:10.1093/eurheartj/eht288

Cited by 191 publications

(152 citation statements)

References 18 publications

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“…A recent systematic review detected approximately 202 million people living with PAD worldwide [1]. In Germany, endovascular revascularizations (ER), especially for critical limb ischaemia (CLI), increased by 46 % from 2005 to 2009 [2]. The German Federal Statistics Bureau reported more than 230,000 peripheral interventions for PAD in 2013 [3].…”

Section: Introductionmentioning

confidence: 99%

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Rieß

Debus

Heidemann

et al. 2017

Vasa

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Summary:Background: Despite ongoing research concerning comorbidities and clinical presentation of peripheral arterial disease (PAD), the issue of gender associated differences in treatment is far from being settled. Patients and methods: This was a prospective, non-randomized multicentre study design. All patients suffering from intermittent claudication (IC) or critical limb ischaemia (CLI) were included. Results: A total of 2,798 procedures for symptomatic PAD in the infrainguinal region were recorded, with 1,696 (61.4 %) males. Distribution of comorbidities for patients with IC were gender-specifi cally different. Smoking was more common in men (41.9 vs. 31.9 %, p < .001), men had more often previous coronary heart disease (35.2 vs. 27.7 %, p = .007), and suffered more often from diabetes (33.9 vs. 28.2 %, p = .037). Women were generally older (71 vs. 77 years). Men were more prone to present with IC (46.9 vs. 43.6 %, p < .001) and ulcer/gangrene (43.6 vs. 41.2 %, p < .001). Women were more likely to present with rest pain (9.5 vs. 15.1 %, p < .001). Men were more often treated for a lesion below the knee (BTK) (21.1 vs. 14.9 %, p < .001), and females above the knee (ATK) (58.1 vs. 61.5 %, p < .001). Logistic regression analysis revealed a signifi cant association of male gender and treatment for lesions BTK (OR 1.565, 95 % CI 1.281-1.913, p < .001). Dissections and bleeding complications were more often observed in females with IC (3.3 vs. 7.2 %, p = 0.003; 0.4 vs. 1.5 %, p = 0.044). Women were rather discharged to rehabilitation and had a longer hospital stay compared to men (3.4 vs. 8.9 %, p < .001; three vs. four days, p = .023). Conclusions: The present study provides an overview on gender-specifi c differences in endovascular treatment of PAD. To date, available evidence on this topic is limited, emphasising the importance of further vascular research targeting this topic.

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Section: Introductionmentioning

confidence: 99%

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Rieß

Debus

Heidemann

et al. 2017

Vasa

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“…Subclinical PAD has previously been reported to negatively aff ect patient prognosis, and treatment of PAD has been shown to be benefi cial at any stage of disease [7,14]. In view of the worldwide aging population, the prevalence of PAD is predicted to increase, constituting a medical socioeconomic challenge for health care providers, as recently shown in a nationwide analysis in Germany [15].…”

Section: Introductionmentioning

confidence: 96%

Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting

Freisinger

Malyar

Reinecke

2016

Vasa

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Summary:Background: Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular morbidity and mortality. The objective of this nationwide analysis was to explore the association of PAD with in-hospital mortality in patients hospitalized for acute myocardial infarction (AMI). Patients and methods: Data on all in-patient hospitalizations in Germany are continuously transferred to the Federal Statistical Offi ce (DESTATIS), as required by federal law. These case-based data on AMI in the years 2005, 2007 and 2009 were analyzed regarding ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) as the primary diagnoses and concomitant PAD as the secondary diagnosis with respect to age and gender related disparity. Results: We analyzed 619,103 AMI cases, including 270,026 (43.6 %) with STEMI and 349,077 (56.4 %) with NSTEMI. The PAD ratio was 3.4 % in STEMI and 5.7 % in NSTEMI. In STEMI, in-hospital mortality was 15.6 % in cases with PAD vs. 12.0 % without, and 12.0 % vs. 9.8 % in NSTEMI, respectively (P < 0.001; 2009). Although female gender was associated with a signifi cantly higher in-hospital mortality, the presence of PAD particularly negatively affected in-hospital mortality in men (+ 60 % male vs -11 % female in STEMI; + 33 % male vs -3 % female in NSTEMI). Conclusions: Our data demonstrate the adverse impact of concomitant PAD on in-hospital mortality in AMI, in a large-scale, real-world scenario. Further research, particularly with a focus on gender, is needed to identify diagnostic and therapeutic measures to reduce the remarkably high in-hospital mortality of AMI patients with concomitant PAD.

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“…3,4 As the overall prevalence of type 2 diabetes increases, the burden of diabetes-induced vascular diseases is a growing problem in Western societies. 5 Within the vascular tree, diabetes potentially affects macro-as well as microcirculatory territories. 6 In large vessels, diabetes contributes to the development of cardiovascular diseases, while microvascular dysfunction typically manifests as retinopathy, nephropathy and neuropathy.…”

Section: Introductionmentioning

confidence: 99%

Microvascular function in women with former gestational diabetes: A cohort study

Charwat-Resl

Yarragudi

Heimbach

et al. 2017

Diabetes and Vascular Disease Research

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Objective: In the long term, diabetes mellitus is potentially associated with the occurrence of microvascular damage. This study sought to assess whether a history of prior gestational diabetes mellitus is associated with long-term effects on the women's microcirculation. Methods: Within the scope of a long-term follow-up of the 'Viennese Post-Gestational Diabetes Project', women with prior gestational diabetes mellitus as well as women with previous pregnancy but with no history of gestational diabetes mellitus (controls) were enrolled in this cross-sectional study. Microvascular function was assessed by post-occlusive reactive hyperaemia using laser Doppler fluxmetry. Baseline perfusion, biological zero, peak perfusion, time to peak and recovery time were recorded and compared between both groups. Results: Microvascular function was assessed in 55 women with prior gestational diabetes mellitus (46.1 ± 4.6 years) and 32 women with previous pregnancy but without prior gestational diabetes mellitus (42.9 ± 5.3 years). The mean period of time between delivery and the assessment of microvascular function was 16.2 ± 5.2 years in women with prior gestational diabetes mellitus group and 14.2 ± 4.8 years in controls. Regarding microvascular function, baseline perfusion, biological zero, peak perfusion, time to peak and recovery time did not differ between women with prior gestational diabetes mellitus and controls (all p > 0.05). Conclusion:In the long term, microvascular function appears not to be impaired in women with prior gestational diabetes mellitus.

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Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis

Abstract: This population-based analysis documents the significant rise of PAD, particularly of the CLI subset, and highlights the malign prognosis associated with PAD as indicated by high amputation and in-hospital mortality rates.

Cited by 191 publications

References 18 publications

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting

Microvascular function in women with former gestational diabetes: A cohort study

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