scholarly journals Lower Extremity Bypass Is Associated with Lower Short-Term Major Adverse Limb Events and Equivalent Major Adverse Cardiac Events Compared with Endovascular Intervention in A National Cohort with Critical Limb Ischemia

2017 ◽  
Vol 65 (1) ◽  
pp. e4-e5 ◽  
Author(s):  
James H. Mehaffey ◽  
Robert Hawkins ◽  
Anna Fashandi ◽  
Margret C. Tracci ◽  
Kenneth Cherry ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Endovascular Intervention ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Short Term ◽  
Adverse Cardiac Events ◽  
National Cohort

Contemporary Endovascular 30-Day Outcomes for Critical Limb Threatening Ischemia Relative to Surgical Bypass Grafting

2021 ◽  
pp. 153857442198951
Author(s):  
Christopher Alan Latz ◽  
Laura Boitano ◽  
Linda J. Wang ◽  
Anna A. Pendleton ◽  
Charles DeCarlo ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Inverse Probability Weighting ◽  
Major Amputation ◽  
Endovascular Intervention ◽  
Major Adverse Cardiac Events ◽  
Probability Weighting ◽  
Cardiac Events ◽  
Inverse Probability ◽  
Adverse Cardiac Events ◽  
Surgical Bypass

Objectives: Data from 2011-2014 showed lower extremity bypass(LEB) outperforming infrainguinal endovascular intervention(IEI) regarding major adverse limb events(MALE) but noted no significant difference in major adverse cardiac events(MACE) in propensity matched cohorts. This study aimed to determine if more recent(2015-2018) endovascular outcomes data have improved relative to surgical bypass. Methods: Patients who underwent intervention for chronic limb threatening ischemia (CLTI) from 2015-2018 were identified using the American College of Surgeons National Quality Improvement Program(NSQIP) Vascular Surgery module. The cohort was categorized as undergoing lower extremity bypass(LEB) or infrainguinal endovascular intervention(IEI). Primary 30-day outcomes included major adverse cardiac events(MACE), major adverse limb events(MALE), and major amputation. Inverse probability weighting was used for multivariable analysis. Results: A total of 10,783 patients underwent an infrainguinal intervention for CLTI from 2015-2018. Of these, 6,003(55.7%) underwent LEB and 4,780(44.3%) underwent IEI. Forty percent of the cohort was considered “high anatomic risk” by Objective Performance Goals(OPG) standards, and 13.6% were considered “high clinical risk.” The IEI cohort vs. the LEB cohort experienced a Myocardial infarction(MI)/Stroke rate of 1.8% vs. 3.6%(p < .001), and had a mortality rate of 2.0% vs. 1.7%(p = .22), which yielded a composite MACE of 3.4% vs. 4.8%(p = .001). The rate of reintervention for IEI vs LEB was 4.4% vs. 5.3%(p = .04), the loss of patency (without re-intervention) rate was 1.8% vs. 1.8%(p = 1.0), and the major amputation rate was 4.1% vs. 3.5%(p = .15), which resulted in a MALE rate of 9.1% vs. 8.8%(p = .50). Following inverse probability weighting, comparing the IEI to the referent LEB, MALE AOR = 1.17, 95% CI[1.01 -1.36], p = .036, MACE AOR = 0.61, 95% CI[0.49-0.74], p < .001, and major amputation AOR = 1.31, 95% CI[1.05 -1.62], p = .016. Conclusion: Endovascular outcomes continue to demonstrate inferiority in major amputation and overall MALE. However, endovascular intervention has a significantly reduced incidence of MACE. Overall, these results demonstrate an improvement in endovascular MACE rates in recent years relative to surgical bypass.

Sarcopenia is a risk factor for major adverse cardiac events after surgical revascularization for critical limb ischemia

Vascular ◽  
2022 ◽  
pp. 170853812110593
Author(s):  
Nehir Selçuk ◽  
Şebnem Albeyoğlu ◽  
Murat Bastopcu ◽  
İsmail Selçuk ◽  
Hakan Barutca ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Psoas Muscle ◽  
Limb Ischemia ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Surgical Revascularization ◽  
Computed Tomography Images ◽  
Adverse Cardiac Events ◽  
History Of ◽  
Low Sensitivity

Objectives We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients. Methods This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm2/m2 for men and PMI < 4.0 cm2/m2 for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients. Results The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, p < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, p = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, p = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, p = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia. Conclusions Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.

scholarly journals Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 588
Author(s):  
Aydin Rodi Tosu ◽  
Muhsin Kalyoncuoglu ◽  
Halil İbrahim Biter ◽  
Sinem Cakal ◽  
Murat Selcuk ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Short Term ◽  
Cox Regression Analysis ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Auc Value ◽  
Immune Inflammation

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001–1.003, p < 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was >1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p < 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

A Comparison of Outcomes after Lower Extremity Bypass and Repeat Endovascular Intervention following Failed Previous Endovascular Intervention for Critical Limb Ischemia

2018 ◽  
Vol 48 ◽  
pp. 24
Author(s):  
Alexander H. Shannon ◽  
J. Hunter Mehaffey ◽  
J. Michael Cullen ◽  
Irving L. Kron ◽  
Gilbert R. Upchurch ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Endovascular Intervention

scholarly journals Prior failed ipsilateral percutaneous endovascular intervention in patients with critical limb ischemia predicts poor outcome after lower extremity bypass

2011 ◽  
Vol 54 (3) ◽  
pp. 730-736 ◽  
Author(s):  
Brian W. Nolan ◽  
Randall R. De Martino ◽  
David H. Stone ◽  
Andres Schanzer ◽  
Philip P. Goodney ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Endovascular Intervention ◽  
Poor Outcome
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