February 12, 2020
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Subsequent risk elevated after hospitalization for major adverse limb events

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Among patients who underwent peripheral artery revascularization, those who were subsequently hospitalized at least once for a major adverse limb event had elevated risk for cardiac and limb events compared with those who were not, researchers reported.

Connie N. Hess, MD, MHS, interventional cardiologist and associate professor of medicine at the University of Colorado and clinician-scientist at CPC Clinical Research, and colleagues analyzed 393,017 patients (mean age, 69 years; 41% women) from the Premier Healthcare Database who underwent peripheral artery revascularization between 2009 and September 2015.

Among the cohort, 77.9% had an endovascular procedure, 11.3% had an open surgical procedure and 10.8% had a hybrid procedure.

During a median follow-up of 2.7 years, the cumulative incidence of MI or stroke was 9.8%; the cumulative incidence of a major adverse limb event, defined as amputation or peripheral revascularization, was 41.9%; and 12.9% of patients had at least one hospitalization for a major adverse limb event, according to the researchers.

In time-dependent covariate-adjusted models, the researchers found postprocedural hospitalization for a major adverse limb event conferred elevated risk for MI or stroke (HR = 1.34; 95% CI, 1.28-1.4) and for major amputation or peripheral revascularization (HR = 8.13; 95% CI, 7.96-8.29).

After peripheral revascularization, rates of limb events were high in the first year but subsequently slowed, whereas rates of cardiac events rose consistently over time, Hess and colleagues wrote.

“Providers caring for patients with peripheral artery disease should be made aware of these long-term postprocedure risks and their timing,” the researchers wrote. “Focusing on optimizing procedural factors and periprocedural care may help reduce early post-revascularization limb events, whereas efforts to reduce cardiovascular events should target long-term secondary prevention.”

Jeffrey W. Olin

In a related editorial, Jeffrey W. Olin, DO, professor of medicine at the Icahn School of Medicine at Mount Sinai and director of vascular medicine and the Vascular Diagnostic Laboratory in the Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health of The Mount Sinai Medical Center, and Hillary Johnston-Cox, MD, PhD, cardiology fellow at Perelman School of Medicine, University of Pennsylvania, wrote: “Given that 70% of subjects in this study underwent revascularization for claudication, a more detailed account of the anatomy and specific indications for intervention may help clarify the reason(s) why the post-revascularization outcomes were so poor. These are the types of details that are necessary to elucidate when quantifying the risk for invasive procedures in high-risk patients.” – by Erik Swain

Disclosures: The analysis was supported by a research grant from Merck. Hess reports she received institutional research grants from Amgen, Bayer and Merck. Johnston-Cox reports no relevant financial disclosures. Olin reports he serves on an advisory board for Janssen and served on the steering committee of a trial sponsored by Merck. Please see the study for all other authors’ relevant financial disclosures.