August 22, 2018
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Hospitalization for major adverse limb events occurs in 1 in 10 within a year after peripheral revascularization

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In contemporary practice, 1 year after peripheral revascularization, 1 in 10 patients are hospitalized for major adverse limb events, researchers reported in the Journal of the American College of Cardiology.

The study included 381,415 patients who underwent peripheral artery revascularization from January 2009 to September 2014. Researchers analyzed the primary outcome of 1-year major adverse limb event hospitalization. Major adverse limb events were defined as acute limb ischemia, including thrombectomy and thrombolysis; major amputation at or above the ankle; and/or need for surgical peripheral revascularization.

Within 1 year after the index revascularization, 10.3% of patients were hospitalized for a major adverse limb event (2.6% for acute limb ischemia; 3.5% for major amputation; 6% for surgical revascularization), 12.8% had a CV hospitalization, 18.8% had a limb-related hospitalization and 38.9% had any inpatient hospitalization. Eleven percent of patients required outpatient endovascular revascularization within 1 year.

The researchers also addressed temporal trends over time and found that limb-related, CV and all-cause hospitalizations decreased from 2009 to 2014, but rates of outpatient endovascular revascularizations increased.

“Within 1 year after the index revascularization, a significant proportion of patients were hospitalized for limb-related and cardiovascular causes, with 1 in 10 patients admitted for major adverse limb events. Although overall subsequent hospitalizations trended down during the study period, the residual risk for postprocedure limb-related and cardiovascular events remains high,” Connie N. Hess, MD, MPH, from the division of cardiology at University of Colorado School of Medicine, Aurora, and CPC Clinical Research, and colleagues wrote in the study.

The researchers identified several factors associated with increased risk for hospitalization for major adverse limb events within 1 year, including:

  • male sex;
  • black race;
  • Medicare and Medicaid insurance;
  • diabetes;
  • renal insufficiency;
  • HF;
  • smoking;
  • critical limb ischemia or acute limb ischemia at baseline;
  • a surgical or hybrid procedure;
  • a procedure performed by a noncardiology operator; and
  • discharge on oral anticoagulation.

The median patient age in this study was 69 years, 42% were women, most patients were white and Medicare insurance was common. Patients enrolled presented with a significant burden of medical comorbidities, according to the researchers, including high rates of hypertension, diabetes, ischemic heart disease, smoking and renal insufficiency.

Nearly three-quarters (71%) of patients underwent revascularization for symptomatic PAD; the remainder were performed for critical limb ischemia (26.2%) and acute limb ischemia (3.2%). Most revascularization procedures — inpatient or outpatient — were performed by cardiology or vascular surgery professionals.

“Based on these findings, efforts to reduce the burden of comorbidities, improve surgical revascularization techniques or concomitant antithrombotic therapies and implement a multidisciplinary approach to the care of PAD patients may represent actionable strategies to reduce hospitalization for major adverse limb events,” Hess and colleagues concluded. – by Katie Kalvaitis

Disclosures: This analysis was funded by a research grant from Merck. Hess reports she has received research funding to CPC Clinical Research from Bayer and Merck. Please see the full study for the other authors’ relevant financial disclosures.