ACE inhibitors beneficial in endovascular intervention for CLI
Among patients who had endovascular interventions for critical limb ischemia, those taking ACE inhibitors had higher rates of overall and amputation-free survival than those not taking them, according to results presented at the Society for Vascular Surgery Vascular Annual Meeting.
Sikandar Khan, MD, clinical assistant professor of surgery at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and colleagues analyzed patients listed in the Vascular Quality Initiative database who underwent an endovascular intervention for CLI between April 2010 and January 2017. The cohort included 11,331 patients with 12,433 affected limbs.
“CLI represents the advanced stage of PAD, and CLI patients are at high risk for adverse cardiovascular events,” Khan told Cardiology Today’s Intervention. “Optimizing medical management in CLI patients can improve their outcomes. Our study shows that these drugs are associated with improved amputation-free survival and overall survival.”
Outcomes of interest included limb salvage, amputation-free survival and overall survival.
Compared with those not taking ACE inhibitors, those taking them more often had CAD, diabetes and hypertension and less often had end-stage renal disease or prior tissue loss as an indication for intervention (P < .001 for all), according to the researchers.
Types of intervention included angioplasty, angioplasty plus stenting, angioplasty plus stenting with or without a stent graft and atherectomy, and did not vary between the groups.
ACE inhibitors were independently associated with improved overall survival (HR = 0.79; 95% CI, 0.69-0.91) and amputation-free survival (HR = 0.87; 95% CI, 0.79-0.96) but not limb salvage (HR = 0.95; 95% CI, 0.83-1.07), Khan and colleagues found.
“Further research is required to investigate the use of ACE inhibitors in this patient population, especially CLI patients without other indications for ACE therapy,” the researchers wrote in an abstract. – by Erik Swain
Khan S, et al. Abstract VESS03. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 12-15, 2019; National Harbor, Md.
Disclosures: The authors report no relevant financial disclosures.