scholarly journals A Hospital Discharge Risk Score for 1-Year All-cause Mortality or Non-fatal Cardiovascular Events in Patients with Lower-extremity Peripheral Artery Disease, with and without Revascularisation

2013 ◽  
Vol 45 (5) ◽  
pp. 488-496 ◽  
Author(s):  
N. Pros ◽  
J.P. Cambou ◽  
V. Aboyans ◽  
J. Malloizel Delaunay ◽  
J. Constans ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hospital Discharge ◽  
Peripheral Artery Disease ◽  
Risk Score ◽  
Cardiovascular Events ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Artery Disease

scholarly journals Association between Peripheral Artery Disease and Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome: Findings from the Gulf COAST Registry

2019 ◽  
Vol 28 (5) ◽  
pp. 410-417 ◽  
Author(s):  
Ibrahim Al-Zakwani ◽  
Ekram Al Siyabi ◽  
Najib Alrawahi ◽  
Arif Al-Mulla ◽  
Abdullah Alnaeemi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cardiovascular Events ◽  
Arabian Gulf ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Vascular Insufficiency ◽  
All Cause Mortality ◽  
Artery Disease

Objective: To evaluate the association between peripheral artery disease (PAD) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Methods: Data from 4,044 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013 were analyzed. PAD was defined as any of the following: claudication, amputation for arterial vascular insufficiency, vascular reconstruction, bypass surgery, or percutaneous intervention in the extremities, documented aortic aneurysm or an ankle brachial index of <0.8 in any of the legs. MACE included stroke/transient ischemic attack (TIA), myocardial infarction (MI), all-cause mortality, and readmissions for cardiac reasons diagnosed between hospital admission and at 1-year post discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years and 66% (n = 2,686) were males. A total of 3.3% (n = 132) of the patients had PAD. Patients with PAD were more likely to be associated with smoking, prior MI, hypertension, diabetes mellitus, and stroke/TIA. At the 1-year follow-up, patients with PAD were significantly more likely to have MACE (adjusted OR [aOR], 2.07; 95% confidence interval [CI]: 1.41–3.06; p< 0.001). The higher rates of events were also observed across all MACE components; stroke/TIA (aOR, 3.22; 95% CI: 1.80–5.75; p< 0.001), MI (aOR, 2.15; 95% CI: 1.29–3.59; p =0.003), all-cause mortality (aOR, 2.21; 95% CI: 1.33–3.69; p =0.002), and readmissions for cardiac reasons (aOR, 1.83; 95% CI: 1.24–2.70; p =0.003). Conclusions: PAD was significantly associated with MACE in ACS patients in the Arabian Gulf.

Medical Management of Lower Extremity Manifestations of Peripheral Artery Disease

2015 ◽  
Author(s):  
Mary M. McDermott
Keyword(s):  
United States ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Medical Management ◽  
Cardiovascular Events ◽  
The United States ◽  
Peripheral Artery ◽  
Exercise Interventions ◽  
Medical Therapies ◽  
Artery Disease

Lower extremity peripheral artery disease (PAD) affects eight million people in the United States and over 200 million men and women worldwide. Furthermore, recent evidence from the Global Disease Burden suggests that the prevalence of PAD increased worldwide by 20% between 2000 and 2010. Patients with PAD are at increased risk for cardiovascular events, functional impairment, and mobility loss. With advancements in medical science and improved treatments for cardiovascular disease, rates of cardiovascular events have declined in the United States and in other high socioeconomic countries. Consequently, people are living longer with chronic debilitating diseases, such as PAD. Optimal medical management of patients with PAD is essential to help these patients survive longer with optimal quality of life and without disability. This review covers medical therapies to improve lower extremity functioning in people with PAD, additional medications to improve walking performance in PAD, and both walking and nonwalking exercise interventions for lower extremity PAD,  Tables outline outcome measures typically used to assess improvement in response to medical therapies for PAD; FDA-approved medications and medications that may be beneficial but are not FDA-approved for intermittent claudication symptoms; exercise therapies that benefit patients with PAD; and additional considerations regarding exercise therapy in PAD. Graphs showcase ramipril versus placebo and changes in walking time according to home-based versus supervised walking exercise. This review contains 2 figures, 5 tables, and 68 references.

scholarly journals An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease

2012 ◽  
Vol 56 (3) ◽  
pp. 686-695 ◽  
Author(s):  
Christopher D. Owens ◽  
Ji Min Kim ◽  
Nathanael D. Hevelone ◽  
Warren J. Gasper ◽  
Michael Belkin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Prediction Model ◽  
Peripheral Artery Disease ◽  
Bypass Surgery ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Artery Disease

Medical Management of Lower Extremity Manifestations of Peripheral Artery Disease

2015 ◽  
Author(s):  
Mary M. McDermott
Keyword(s):  
United States ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Medical Management ◽  
Cardiovascular Events ◽  
The United States ◽  
Peripheral Artery ◽  
Exercise Interventions ◽  
Medical Therapies ◽  
Artery Disease

Lower extremity peripheral artery disease (PAD) affects eight million people in the United States and over 200 million men and women worldwide. Furthermore, recent evidence from the Global Disease Burden suggests that the prevalence of PAD increased worldwide by 20% between 2000 and 2010. Patients with PAD are at increased risk for cardiovascular events, functional impairment, and mobility loss. With advancements in medical science and improved treatments for cardiovascular disease, rates of cardiovascular events have declined in the United States and in other high socioeconomic countries. Consequently, people are living longer with chronic debilitating diseases, such as PAD. Optimal medical management of patients with PAD is essential to help these patients survive longer with optimal quality of life and without disability. This review covers medical therapies to improve lower extremity functioning in people with PAD, additional medications to improve walking performance in PAD, and both walking and nonwalking exercise interventions for lower extremity PAD,  Tables outline outcome measures typically used to assess improvement in response to medical therapies for PAD; FDA-approved medications and medications that may be beneficial but are not FDA-approved for intermittent claudication symptoms; exercise therapies that benefit patients with PAD; and additional considerations regarding exercise therapy in PAD. Graphs showcase ramipril versus placebo and changes in walking time according to home-based versus supervised walking exercise. This review contains 2 figures, 5 tables, and 68 references.

Contemporary Medical Management of Peripheral Artery Disease

2021 ◽  
Vol 128 (12) ◽  
pp. 1868-1884
Author(s):  
Marc P. Bonaca ◽  
Naomi M. Hamburg ◽  
Mark A. Creager
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Cardiovascular Events ◽  
Limb Ischemia ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Walking Capacity ◽  
Medical Therapies ◽  
Artery Disease

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior critical limb ischemia, prior lower extremity revascularization, or amputation have a heightened risk of major adverse limb events. Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical therapies currently available to improve outcomes in patients with PAD.

scholarly journals Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Jennifer A. Rymer ◽  
Hillary Mulder ◽  
Kim G. Smolderen ◽  
William R. Hiatt ◽  
Michael S. Conte ◽  
...  
Keyword(s):  
Health Status ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Vas Scores ◽  
Artery Disease ◽  
Lower Extremity Revascularization

Background There are limited data on health status instruments in patients with peripheral artery disease and cardiovascular and limb events. We evaluated the relationship between health status changes and cardiovascular and limb events. Methods and Results In an analysis of the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) trial, we examined the characteristics of 13 801 patients by tertile of health status instrument scores collected in the trial (EuroQol 5‐Dimensions [EQ‐5D], EQ visual analog scale [VAS], and peripheral artery questionnaire). We assessed the association between the baseline health status measurements and major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization procedures during trial follow‐up and the association between 12‐month health status change scores and subsequent end points during follow‐up. There were 13 217 (95%) patients with EQ‐5D scores, 13 533 (98%) with VAS scores, and 4431 (32%) with peripheral artery questionnaire scores. Patients in the lowest baseline EQ‐5D tertile (0 to <0.69) were more likely to be female with severe claudication compared with the highest tertile (0.79–1.0; P <0.01). Patients in the lowest VAS (0–60) and peripheral artery questionnaire (0–49) tertiles had lower ankle–brachial indices compared with the highest tertiles (80–100 and 76–108, respectively; P <0.01). There was a significant association between baseline EQ‐5D, VAS, and peripheral artery questionnaire scores and adjusted major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization ( P <0.05). Improved EQ‐5D and VAS scores over 12 months were associated with reduced risk of subsequent major adverse cardiovascular events or lower‐extremity revascularization (all P <0.01). Conclusions Although health status instruments are rarely used in clinical practice, these measures are associated with outcomes, including major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization. Further research is needed to determine the relationship between changes in these instruments, revascularization, and outcomes.

Calcification Propensity in Serum and Cardiovascular Outcome in Peripheral Artery Disease

2021 ◽  
Author(s):  
Marija Bojic ◽  
Bernhard Bielesz ◽  
Daniel Cejka ◽  
Gerit-Holger Schernthaner ◽  
Clemens Höbaus
Keyword(s):  
Cardiovascular Risk ◽  
Peripheral Artery Disease ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Study Cohort ◽  
Peripheral Artery ◽  
Multivariate Adjustment ◽  
All Cause Mortality ◽  
Artery Disease

AbstractPeripheral artery disease (PAD) has been shown to be linked to elevated cardiovascular risk. The novel T50 test quantifies calcification propensity of serum and has been associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD) and in the general population. This study investigated the association of calcification propensity measured by the T50 test in 287 patients with PAD without severe CKD. Major cardiovascular events (MACEs) including nonfatal stroke and nonfatal myocardial infarction and all-cause death (MACE + ) were evaluated after a median follow-up of 4 years and long-term cardiovascular and all-cause mortality after a median follow-up of 8.7 years by Kaplan–Meier and Cox regression analyses. Mean T50 time was 268 ± 63 minutes in the study cohort (age 69 ± 10 years, 32% women, 47% diabetes). Low T50 values that signify high calcification propensity were significantly associated with the occurrence of MACE+ (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.55–0.94). This association sustained multivariate adjustment for cardiovascular risk factors (CVRFs), Fontaine PAD stage, and prevalent media sclerosis (HR: 0.65; CI: 0.47–0.91). Cardiovascular mortality was significantly associated with T50 after multivariate adjustment for CVRF (HR: 0.72; CI 0.53–0.99), but not all-cause mortality (HR: 0.80; CI: 0.64–1.01). In conclusion, calcification propensity associates with MACE+ and cardiovascular mortality in patients with PAD.

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