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Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45:3538-3700. [PMID: 39210722 DOI: 10.1093/eurheartj/ehae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Niiranen O, Virtanen J, Rantasalo V, Ibrahim A, Venermo M, Hakovirta H. The Association between Major Adverse Cardiovascular Events and Peripheral Artery Disease Burden. J Cardiovasc Dev Dis 2024; 11:157. [PMID: 38921658 PMCID: PMC11203764 DOI: 10.3390/jcdd11060157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). METHODS All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system. RESULTS The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4-6.5) and for MACEs overall (OR 2.3; 95%CI 1.4-3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6-8.0 for HF and an OR 3.1; and 95%CI 1.7-5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6-3.2) and MACE (OR 1.9; 95%CI 1.3-2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs. CONCLUSIONS PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased.
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Affiliation(s)
- Oskari Niiranen
- Department of Surgery, University of Turku, 20520 Turku, Finland; (O.N.)
| | - Juha Virtanen
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland; (J.V.); (M.V.)
| | - Ville Rantasalo
- Department of Surgery, University of Turku, 20520 Turku, Finland; (O.N.)
| | - Amer Ibrahim
- Department of Surgery, KFSHRC, King Faisal Specialist Hospital and Research Centre, Madinah 11211, Saudi Arabia;
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland; (J.V.); (M.V.)
| | - Harri Hakovirta
- Department of Surgery, University of Turku, 20520 Turku, Finland; (O.N.)
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland; (J.V.); (M.V.)
- Department of Surgery, Satasairaala, 28500 Pori, Finland
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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Salle L, Magne J, Kenne Malaha A, Chastaingt L, Galinat S, Drutel A, Lacroix P, Teissier-Clément MP, Aboyans V. Ultrasound-detected tibial artery calcification as a marker of cardiovascular and lower-limb risk in asymptomatic patients with type-2 diabetes. Vasc Med 2023; 28:538-546. [PMID: 37610880 DOI: 10.1177/1358863x231190433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Medial arterial calcification (MAC) is a vascular disease distinct from atherosclerosis. Recently, several studies have demonstrated that MAC is an important marker of cardiovascular events. We aim to assess the presence of MAC during ultrasound screening of lower-limb vasculature and its association with both cardiovascular (CV) and lower-limb events in patients with type-2 diabetes. METHODS A retrospective cohort study was conducted on 1119 patients with type-2 diabetes free from CV disease. A CV work-up, including vascular ultrasound, was performed for each patient. The presence of MAC was assessed on posterior tibial arteries and ankle-brachial index (ABI) was measured. Major acute CV events (MACEs) and lower-limb events (MALEs) were recorded as a composite endpoint for a 5-year period. RESULTS We identified MAC among 212 (18.9%) patients. The independent determinants of MAC were age and diabetic retinopathy. Over a period of 5 years, 125 MACEs and 22 MALEs occurred. MAC was significantly associated with the composite outcome MACE + MALE (HR = 1.94; 95% CI: 1.23, 3.08, p = 0.005) or with MACE (HR = 1.85; 95% CI: 1.16, 2.95, p = 0.010). Adjusted for ABI and diabetic foot wound, MAC remained a determinant of MALE (HR = 5.49; 95% CI: 2.19, 13.76, p < 0.001). Considering each ABI group, MAC was associated with both MACE and MALE in the normal ABI group. CONCLUSIONS Ultrasound-detected MAC on tibial arteries seems to be a determinant of both CV and lower-limb events, independent from ABI. MAC helps to refine the CV risk in patients with normal ABI.
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Affiliation(s)
- Laurence Salle
- Department of Diabetology and Endocrinology, Dupuytren-2 University Hospital Center, Limoges, France
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Cardiology, Dupuytren-2 University Hospital Center, Limoges, France
| | - Angeladine Kenne Malaha
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Lucie Chastaingt
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Vascular Surgery & Medicine, Dupuytren-2 University Hospital Center, Limoges, France
| | - Sophie Galinat
- Department of Diabetology and Endocrinology, Dupuytren-2 University Hospital Center, Limoges, France
| | - Anne Drutel
- Department of Diabetology and Endocrinology, Dupuytren-2 University Hospital Center, Limoges, France
| | - Philippe Lacroix
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Vascular Surgery & Medicine, Dupuytren-2 University Hospital Center, Limoges, France
| | - Marie-Pierre Teissier-Clément
- Department of Diabetology and Endocrinology, Dupuytren-2 University Hospital Center, Limoges, France
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Victor Aboyans
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Cardiology, Dupuytren-2 University Hospital Center, Limoges, France
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Long-Term Prognosis after Coronary Artery Bypass Grafting: The Impact of Arterial Stiffness and Multifocal Atherosclerosis. J Clin Med 2022; 11:jcm11154585. [PMID: 35956199 PMCID: PMC9369624 DOI: 10.3390/jcm11154585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/24/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to study the effect of arterial stiffness and multifocal atherosclerosis on the 10-year prognosis of patients after coronary artery bypass grafting. Methods. Patients with coronary artery disease (n = 274) who underwent coronary artery bypass grafting (CABG), in whom cardio-ankle vascular index (CAVI) was assessed using the VaSera VS-1000 device and the presence of peripheral atherosclerosis in Doppler ultrasound. Groups were distinguished with normal CAVI (<9.0, n = 163) and pathological CAVI (≥9.0, n = 111). To assess the prognosis, coronary and non-coronary death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, repeated CABG, percutaneous coronary intervention, carotid endarterectomy, peripheral arterial surgery, pacemaker implantation were analyzed. Results. During the observation period, mortality was 27.7%. A fatal outcome from all causes was in 37 (22.7%) patients in the group with normal CAVI and in 39 (35.14%) in the group with pathological CAVI (p = 0.023). Death from cardiac causes was more common in the group with CAVI ≥ 9.0—in 25 cases (22.52%) than in the group with CAVI < 9.0—in 19 (11.6%, p = 0.016). The combined endpoint in patients with pathological CAVI was detected in 66 (59.46%) cases, with normal CAVI values—in 76 (46.63%) cases (p = 0.03). The presence of diabetes mellitus, multifocal atherosclerosis (p = 0.004), pathological CAVI (p = 0.063), and male gender were independent predictors of death at 10-year follow-up after CABG. The presence of multifocal atherosclerosis and pathological CAVI during the preoperative examination of patients were independent predictors of the combined endpoint development. Findings. Patients with coronary artery disease with pathological CAVI before CABG were more likely to experience adverse events and death in the long-term follow-up than patients with normal CAVI. Further studies are needed to investigate the possibility of correcting pathological CAVI after CABG after secondary prevention and the possible impact of this correction on prognosis.
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Aortic calcification index predicts mortality and cardiovascular events in operatively treated patients with peripheral artery disease A prospective PUREASO cohort follow-up study. J Vasc Surg 2022; 76:1657-1666.e2. [PMID: 35810957 DOI: 10.1016/j.jvs.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Present study evaluates the association of aortic calcification to mortality and major adverse cardiovascular and leg events (MACE and MALE) in patients with peripheral artery disease (PAD). The risk for mortality and MACE and MALE events is considered in clinical decision making. METHODS This cohort found in 2012 - 2013 consists of 226 symptomatic PAD patients referred to Turku University Hospital for invasive treatment. Follow-up data about mortality and survival without MACEs and MALEs was collected up to 5 years from inclusion date and aortic calcification index (ACI) was measured from patients with available imaging studies (164 of 226). ACIs association with events and mortality was evaluated in Cox regression, Kaplan-Meier and Classification and regression tree analysis. RESULTS All-cause mortality at 1, 3 and 5 years was 13.7%, (31), 26.1% (59) and 46.9% (106), respectively. In multivariable Cox regression analysis ACI and ACI>43 were independent risk factors for all-cause mortality (HR 1.13 per 10 units 95%CI, 1.00-1.22 and HR 1.83, 95%CI, 1.01-3.32, respectively) and for MACE (HR 1.10 per 10 units, 95%CI, 1.00-1.22 and HR 3.14, 95%CI, 1.67-5.91, respectively), but not for MALES. Classification and regression tree analysis showed that ACI 43 best divides cohort in relation to mortality. Kaplan-Meier analyses showed that ACI>43 is associated with greater mortality and occurrence of MACEs compared to those who have ACI≤43 (log-rank p-value 0.005 and 0.0012, respectively). CONCLUSION Risk for mortality and MACEs is associated with high ACI. ACI can expose PAD patients' risk for further cardiovascular events and mortality.
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Yovera-Aldana M, Pérez-Cavero S, Pinedo-Torres I, Zubiate-López C. Prevalence of Foot At-Risk and its Associated Characteristics among Outpatients with Diabetes Mellitus in a Peruvian Public Hospital. Rev Diabet Stud 2022; 18:1-9. [PMID: 35300751 PMCID: PMC9382682 DOI: 10.1900/rds.2022.18.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the prevalence of patients at risk of developing diabetic foot complications (i.e. foot at-risk) and its clinical components according to the updated International Working Group on Diabetic Foot (IWGDF) criteria and to describe demographic and diabetes-related characteristics. METHODS We conducted a cross-sectional study at María Auxiliadora Hospital between 2017 and 2018. The criteria for foot at-risk in the IWGDF 2019 risk stratification system are classified into four risk categories, R0-R3, ranging from no peripheral arterial disease (PAD) and no peripheral neuropathy (PN) to the presence of PAD or PN in combination with previous foot ulcer, amputation, or end- stage renal disease (R3). According to this system, we obtained prevalence ratios (PR) of foot at-risk categories dependent on sex, age, diabetes duration, and Total Symptom Score. A sample size of 402 subjects was included in the study. RESULTS Subjects included had a mean age of 61 years, and 66% were female. There were no patients with type 1 diabetes, and 59% percent had adiabetes duration of less than ten years. The prevalence of foot at-risk was 54.3% defined by the IWGDF 2019 criteria, which gave prevalence17% higher than that defined with the previous 1999 criteria. PN and PAD frequency was 37.3% and 30.1%, respectively. Foot at-risk prevalence was 40% higher in those with severe Total Symptom Score (PR 1.40, 95% CI 1.09-1.80) and also 39% higher in men than in women (PR 1.39, 95% CI 1.17-1.64). Likewise, diabetes duration of more than ten years had a 25% higher prevalence of foot at-risk (PR 1.25, 95% CI 1.05-1.49), and those older than 60 years had a 20% higher presence of this condition (PR 1.20, 95% CI 1.0011.43). CONCLUSIONS Our hospital faces a substantial burden of diabetic foot risk in men, patients with long diabetes duration, and those with painful neuropathy. More initiatives are required at primary or hospital level to detect this critical condition. Likewise, reference centers with multidisciplinary teams to apply prevention and therapeutic interventions are urgently needed.
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Affiliation(s)
- Marlon Yovera-Aldana
- Neurosciences, Clinical Effectiveness, and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
| | - Sonia Pérez-Cavero
- Endocrinology Service, Department of Medicine, Hospital Maria Auxiliadora, Lima, Peru
| | - Isabel Pinedo-Torres
- Endocrinology Service, Department of Medicine and Office for Teaching Support and Research, OADI, Hospital Daniel Alcides Carrion, Callao, Peru
| | - Carlos Zubiate-López
- Endocrinology Service, Department of Medicine, Hospital Maria Auxiliadora, Lima, Peru
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Lee JY, Lee SJ, Lee SW, Kim TO, Yang Y, Jeong YJ, Park H, Lee J, Hyun J, Kim JH, Lee PH, Kang SJ, Kim YH, Lee CW, Park SW. Long-Term (7-Year) Clinical Implications of Newly Unveiled Asymptomatic Abnormal Ankle-Brachial Index in Patients With Coronary Artery Disease. J Am Heart Assoc 2021; 10:e021587. [PMID: 34632785 PMCID: PMC8751871 DOI: 10.1161/jaha.121.021587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The long-term impact of newly discovered, asymptomatic abnormal ankle-brachial index (ABI) in patients with significant coronary artery disease is limited. Methods and Results Between January 2006 and December 2009, ABI was evaluated in 2424 consecutive patients with no history of claudication or peripheral artery disease who had significant coronary artery disease. We previously reported a 3-year result; therefore, the follow-up period was extended. The primary end point was a composite of all-cause death, myocardial infarction (MI), and stroke over 7 years. Of the 2424 patients with significant coronary artery disease, 385 had an abnormal ABI (ABI ≤0.9 or ≥1.4). During the follow-up period, the rate of the primary outcome was significantly higher in the abnormal ABI group than in the normal ABI group (P<0.001). The abnormal ABI group had a significantly higher risk of composite of all-cause death/MI/stroke than the normal ABI group, after adjustment with multivariable Cox proportional hazards regression analysis (hazard ratio [HR], 2.07; 95% CI, 1.67-2.57; P<0.001) and propensity score-matched analysis (HR, 1.97; 95% CI, 1.49-2.60; P<0.001). In addition, an abnormal ABI was associated with a higher risk of all-cause death, MI, and stroke, but not repeat revascularization. Conclusions Among patients with significant coronary artery disease, asymptomatic abnormal ABI was associated with sustained and increased incidence of composite of all-cause death/MI/stroke, all-cause death, MI, and stroke during extended follow-up over 7 years.
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Affiliation(s)
- Jong-Young Lee
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung-Jae Lee
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung-Whan Lee
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Tae Oh Kim
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Yujin Yang
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Yeong Jin Jeong
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Hanbit Park
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Junghoon Lee
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Junho Hyun
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Ju Hyeon Kim
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Pil Hyung Lee
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Soo-Jin Kang
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Young-Hak Kim
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Cheol Whan Lee
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
| | - Seong-Wook Park
- Division of Cardiology Department of Internal Medicine Asan Medical CenterCollege of MedicineUniversity of Ulsan Seoul Republic of Korea
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Polyvascular disease: A narrative review of current evidence and a consideration of the role of antithrombotic therapy. Atherosclerosis 2020; 315:10-17. [PMID: 33190107 DOI: 10.1016/j.atherosclerosis.2020.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/07/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Polyvascular disease (PVD) affects approximately 20% of patients with atherosclerosis and is a strong independent risk factor for ischemic outcomes. However, guidelines do not address screening or treatment for PVD, and there have been no PVD-specific trials. We reviewed subgroup analyses of large randomized controlled trials of more intense antithrombotic therapy to determine whether increased intensity of therapy improved ischemic outcomes in patients with PVD. METHODS MEDLINE, MEDLINE in-Process, EMBASE, and the Cochrane Library were queried for randomized controlled trials larger than 5000 patients evaluating secondary prevention therapies in patients with coronary artery disease or lower extremity peripheral artery disease. RESULTS Thirteen trials were included ranging in size from 7243 to 27,395 patients. In 9 trials (CHARISMA, TRA 2°P-TIMI 50, PEGASUS-TIMI 54, VOYAGER PAD, TRACER, EUCLID, TRILOGY ACS, PLATO, and COMPASS), patients in the PVD subgroup treated with increased-intensity antithrombotic therapy had similar or greater relative risk reductions for ischemic events in comparison with the general trial cohorts. In four trials (DAPT, THEMIS, APPRAISE-2, and ATLAS ACS 2 TIMI 51), the PVD subgroup had an increased hazard of ischemic events with increased-intensity therapy compared with the general trial cohorts. CONCLUSIONS More intense antithrombotic therapy in patients with PVD was associated with a similar relative risk reduction for ischemic events compared with patients without PVD. Therefore, patients with PVD benefit from a larger absolute risk reduction because of their higher baseline risk. Future trials in patients with atherosclerotic cardiovascular disease should intentionally include PVD patients to adequately assess treatment options for this under-studied, under-treated population.
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Yalım Z, Aldemir M, Emren SV. Association of Inflammatory Markers with Multisite Artery Disease in Patients with Peripheral Arterial Disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 33:55-61. [PMID: 33036788 DOI: 10.1016/j.arteri.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/21/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chronic inflammation plays a considerable role in atherosclerosis and may occur simultaneously in different arteries. This condition is referred to as multisite arterial disease (MSAD). We aimed to investigate the association between inflammatory markers and MSAD. METHODS In this cross-sectional study we included 526 patients with peripheral artery disease (PAD). Patients with PAD were evaluated by conventional or computed tomography angiography for the presence of coronary artery disease (CAD) and those with at least 30% stenosis were included in the study. Patients were divided into two groups: either MSAD+(PAD and CAD), Group 1) or MSAD- (only PAD without CAD, Group 2). Inflammatory markers were compared between the two groups. RESULTS Among all patients, 293 had MSAD while 233 had only PAD. The MSAD+group had higher neutrophil-to-lymphocyte ratio (NLR) and platelet-to-neutrophil ratio (PLR) (5.08±0.19, 4.67±0.51, and 207.1±6.23, 169.3±10.8, respectively, p<0.001). In multivariate analysis, HT [odds ratio (OR): 2.40 (1.61-3.59)); p<0.002], male gender [OR: 2.03 (1.29-3.17); p=0.002], DM [OR:1.56 (1.03-2.36); P=0.035], NLR [OR: 1,08 (1.02-1.16); p=0.021, and PLR [OR:1.05 (1.03-1.08); p<0.001] were found to be associated with MSAD. CONCLUSION NLR and PLR are correlated with MSAD and may indicate the extent of atherosclerosis.
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Affiliation(s)
- Zafer Yalım
- Afyonkarahisar Healty Sciences University, Afyonkarahisar, Afyon, Turkey.
| | - Mustafa Aldemir
- Health Sciences University Bursa Higher Specialization Training And Research Hospital, Department of Cardiovascular Surgery, Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey
| | - Sadık Volkan Emren
- İzmir Katip Çelebi University, Departments of Cardiology, İzmir Katip Celebi Universitesi Tip Fakultesi, İzmir, Turkey
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Poredos P, Blinc A, Novo S, Antignani PL. How to manage patients with polyvascular atherosclerotic disease. Position paper of the International Union of Angiology. INT ANGIOL 2020; 40:29-41. [PMID: 32892614 DOI: 10.23736/s0392-9590.20.04518-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Atherosclerosis is a systemic disease affecting multiple arterial territories. Patients with clinical atherosclerotic disease in one vascular bed are likely to have asymptomatic or symptomatic atherosclerotic lesions in other vascular beds. Specifically, peripheral arterial disease (PAD) often coexists with coronary and carotid disease. With progression of atherosclerotic disease in one vascular bed, the risk of clinical manifestations in other territories increases and the incidence of adverse cardiovascular events increases substantially with the number of affected vascular beds. Classical risk factors are associated with the development of polyvascular atherosclerotic disease (PVD) in different territories; however, to a different extent. Risk modification represents basic treatment of patients with PVD. All modifiable risk factors should be aggressively controlled by lifestyle modification and medication. Particular attention should be directed to patients with PAD who are often undertreated in spite of the proven benefits of guideline-based approach. There is currently no proof that identification of asymptomatic atherosclerosis and PVD improves clinical outcomes in patients who are already in prevention programs. Revascularization should be performed only in symptomatic vascular beds, using the least aggressive method according to consensual decision of a multidisciplinary vascular team.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia -
| | - Ales Blinc
- Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Salvatore Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
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Abstract
An estimated 237 million people suffer from peripheral arterial disease (PAD), which is associated with high morbidity and mortality, and prevalence is still increasing. Currently, we do not have any randomized trials that compare screening to no screening specifically for PAD in the general population. Presently, PAD screening is not generally established. This systematic review gives an overview of relevant literature and guidelines. Screening usually focuses on ankle-brachial index (ABI)-measurement, which enables detection of asymptomatic and symptomatic PAD, but has limitations in diabetics. There are no sufficient data on PAD screening. Guideline recommendations are heterogeneous. While some advocate no screening until better data are available, most recommend selective screening despite insufficient data on morbidity and mortality reduction in consequence of screening. We support the only evidence-based screening strategy for PAD: combined screening for abdominal aortic aneurysm (AAA), PAD and arterial hypertension in men aged 65-74 according to the VIVA study. We additionally suggest a new simple three-step screening strategy for symptomatic PAD in all individuals aged 40 and older, who see a general practitioner: Asking one question ("Do you have pain or cramps in the legs during normal walking?") followed by physical examination (normal lower extremity pulse status?) in those, whose answer is "yes", and ABI measurement unless all pulses are normal.
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Affiliation(s)
- Arne G Kieback
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
| | - Roman Gähwiler
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
| | - Christoph Thalhammer
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
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Is Peripheral Artery Disease an Independent Predictor of Isolated Coronary Artery Bypass Outcome? Heart Lung Circ 2020; 29:1502-1510. [PMID: 32165084 DOI: 10.1016/j.hlc.2020.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/14/2019] [Accepted: 01/11/2020] [Indexed: 11/20/2022]
Abstract
AIM The aim was to use a propensity score-based analysis to determine the impact of peripheral artery disease (PAD) on early outcomes after coronary artery bypass surgery grafting (CABG) in patients with PAD. METHOD We conducted a multicentre retrospective analysis of 11,311 consecutive patients who underwent CABG between 1997 and 2017. Patients with previous or concomitant vascular surgery were excluded. The main endpoints were death, stroke, and limb ischaemia requiring percutaneous or surgical revascularisation. Subgroup analyses were performed to test the interaction of PAD with concomitant factors. RESULTS There was no difference in mortality in patients with and without PAD (p=0.06 and p=0.179, respectively). Patients with PAD had a greater incidence of stroke (p=0.04), acute kidney disease (p=0.003), and limb ischaemia requiring interventions (p<0.001) than those without PAD. The use of off-pump or no-touch aortic techniques did not influence the effect of PAD on the outcomes. Early mortality rate increased in patients with PAD when associated with long cardiopulmonary bypass, cross-clamp times (both p<0.001), and postoperative low cardiac output (p=0.01). CONCLUSIONS The presence of PAD is associated, independently of other factors, with greater incidence of stroke, acute kidney disease, and limb ischaemia following CABG, irrespective of the technique employed. Operative mortality was greater in patients with PAD only when associated with long cardiopulmonary bypass and aortic cross-clamp times, and low cardiac output.
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14
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Bonacchi M, Parise O, Matteucci F, Tetta C, Moula AI, Micali LR, Prifti E, Sani G, Gelsomino S. Early outcomes following isolated coronary artery bypass surgery: Influence of peripheral artery disease. J Card Surg 2019; 34:1470-1477. [PMID: 31536148 DOI: 10.1111/jocs.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine University of Florence Firenze Italy
| | - Orlando Parise
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine University of Florence Firenze Italy
- Cardiothoracic Surgery Department ‐ CARIM Maastricht University Medical Center Maastricht The Netherlands
| | - Francesco Matteucci
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine University of Florence Firenze Italy
- Cardiothoracic Surgery Department ‐ CARIM Maastricht University Medical Center Maastricht The Netherlands
| | - Cecilia Tetta
- Cardiothoracic Surgery Department ‐ CARIM Maastricht University Medical Center Maastricht The Netherlands
| | - Amalia Ioanna Moula
- Cardiothoracic Surgery Department ‐ CARIM Maastricht University Medical Center Maastricht The Netherlands
| | - Linda Renata Micali
- Cardiothoracic Surgery Department ‐ CARIM Maastricht University Medical Center Maastricht The Netherlands
| | - Edvin Prifti
- Division of Cardiac Surgery University Hospital Center of Tirana Tirana Albania
| | - Guido Sani
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine University of Florence Firenze Italy
- Cardiac Surgery Unit, Department of Medical Biotechnologies University of Siena Siena Italy
| | - Sandro Gelsomino
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine University of Florence Firenze Italy
- Cardiothoracic Surgery Department ‐ CARIM Maastricht University Medical Center Maastricht The Netherlands
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15
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 2015] [Impact Index Per Article: 403.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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16
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Khasanov AК, Bakirov BA, Davletshin RA, Nurmukhametova RA, Kudlay DA. [Clinical Features of Comorbid Cluster and Premorbidly Manifestations in Patients with High Vascular Risk in the Middle Age Category with the Presence of Multifocal Atherosclerosis]. ACTA ACUST UNITED AC 2019; 59:31-36. [PMID: 31322087 DOI: 10.18087/cardio.2019.7.n599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to study clinical and cluster features of cardiovascular burdening taking into account the comorbid polymorbid background in patients of middle age (45-60 years) with the presence of multifocal atherosclerosis (MFA). MATERIALS AND METHODS Patients were examined in the Regional Vascular Center of Ufa (RVCU). Depending on the predominant localization of lesions in the vascular bed patients were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and lower limb arteries confirmed by coronary angiography, ultrasound Doppleroscopy of main arteries of the head and lower extremities. Ninety-six patients had predominant lesions in the heart (1st cluster), 96 - in carotid arteries (2nd cluster), and 96 patients had ischemia of lower extremities (3rd cluster). Examination during hospitalization in RVCU included when indicated echocardiography, magnetic resonance imaging of the chest and abdomen, ultrasound studies of abdomen, kidney, and pelvis. RESULTS According to data obtained the following conditions were most often observed in different combinations and with varying degrees of severity of clinical manifestation.Claster 1. Clinical manifestation of atherosclerotic heart disease mainly due to stage III hypertension, history of myocardial infarction were combined with pneumonia, chronic obstructive pulmonary disease with the outcome in pneumosclerosis and emphysema, as well as the presence of cholecysto-cardial syndrome, chronic gastritis, chronic cholecysto-pancreatitis, abdominal ischemic syndrome, rheumatoid arthritis, diabetes mellitus, and chronic pyelonephritis.Claster 2. Hemodynamically significant lesions of brachiocephalic arteries mainly with acute ischemic disturbance of cerebral circulation were combined with bronchial asthma, (the development of which was associated with prolonged persistent eosinophilic inflammation), worsening of chronic kidney disease with urolithiasis, angionephropathy and iron deficiency anemia, as well as the presence of dorsopathy associated with stenotic atherosclerosis of brain vessels.Claster 3.Hemodynamic ischemia with clinical manifestation of vascular lesions of lower extremities was accompanied by type 2 diabetes, chronic cholecysto-pancreatitis, erosive and ulcerative lesions in the stomach and duodenum, polyosteoarthrosis, abdominal-ischemic syndrome. Type 2 diabetes prevailed in patients with occlusion of right posterior tibial artery and trophic ulcer of the right foot. CONCLUSION Interdependence of comorbid and polymorbid background and cardiovascular burdening changes their clinical picture and course, increases number of complications and their severity.
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Affiliation(s)
- A Кh Khasanov
- Bashkiria State Medical University; Emergency Hospital
| | | | | | | | - D A Kudlay
- Institute of Immunology Federal Medical-Biological Agency of Russia
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Le Bivic L, Magne J, Blossier JD, Piccardo A, Wojtyna H, Lacroix P, Mohty D, Cornu E, Le Guyader A, Aboyans V. Mid- and long-term prognosis of off- vs. on-pump coronary artery bypass graft in patients with multisite artery disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:388-395. [PMID: 30465418 DOI: 10.23736/s0021-9509.18.10697-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. METHODS Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. RESULTS MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14). CONCLUSIONS Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.
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Affiliation(s)
- Louis Le Bivic
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Julien Magne
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Jean-David Blossier
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Alessandro Piccardo
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Hélène Wojtyna
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Philippe Lacroix
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Dania Mohty
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Elisabeth Cornu
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Alexandre Le Guyader
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Victor Aboyans
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France - .,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
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18
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Le Bivic L, Magne J, Guy-Moyat B, Wojtyna H, Lacroix P, Blossier JD, Le Guyader A, Desormais I, Aboyans V. The intrinsic prognostic value of the ankle-brachial index is independent from its mode of calculation. Vasc Med 2018; 24:23-31. [PMID: 30426857 DOI: 10.1177/1358863x18807003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The object of this study was to compare the prognostic value of different methods of ankle-brachial index (ABI) calculation. From April 1998 to September 2008, we calculated the ABI in 1223 patients before coronary artery bypass grafting. The ABI was calculated according to five different calculation modes of the numerator. The patients were classified into three groups: clinical peripheral artery disease (PAD), subclinical PAD if no clinical history but abnormal ABI (< 0.90 or > 1.40), and no PAD. The primary outcome was total mortality. During a follow-up of 7.6 years (0.1-15.9), 406 patients (33%) died. The prevalence of the subclinical PAD varied from 22% to 29% according to the different modes of ABI calculation. Areas under the ROC curve to predict mortality according to different calculation modes varied from 0.608 ± 0.020 to 0.625 ± 0.020 without significant differences. The optimal ABI threshold to predict mortality varied for every method, ranging from 0.87 to 0.95. In multivariate models, ABI was significantly and independently associated with total mortality (hazard ratio (HR) = 1.46, 95% CI: 1.15-1.85, p = 0.002); however, this association was not significantly different between the various methods (HRs varying from 1.46 to 1.67). The use of the optimal ABI threshold for each calculation mode (rather than standard 0.90) allowed a slight improvement of the model. In conclusion, the ABI prognostic value to predict mortality is independent from its method of calculation. The use of different optimal thresholds for each method enables a comparable prognosis value.
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Affiliation(s)
- Louis Le Bivic
- 1 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
| | - Julien Magne
- 1 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France.,2 INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
| | - Benoit Guy-Moyat
- 1 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
| | - Hélène Wojtyna
- 1 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
| | - Philippe Lacroix
- 2 INSERM 1094, Faculté de Médecine de Limoges, Limoges, France.,3 CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Vasculaire, et Médecine Vasculaire, Limoges, France
| | - Jean-David Blossier
- 4 CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Cardiaque, Limoges, France
| | - Alexandre Le Guyader
- 4 CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Cardiaque, Limoges, France
| | - Iléana Desormais
- 2 INSERM 1094, Faculté de Médecine de Limoges, Limoges, France.,3 CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Vasculaire, et Médecine Vasculaire, Limoges, France
| | - Victor Aboyans
- 1 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France.,2 INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
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Vlachopoulos C, Georgakopoulos C, Koutagiar I, Tousoulis D. Diagnostic modalities in peripheral artery disease. Curr Opin Pharmacol 2018; 39:68-76. [PMID: 29549715 DOI: 10.1016/j.coph.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/31/2018] [Accepted: 02/22/2018] [Indexed: 01/27/2023]
Abstract
Peripheral artery disease (PAD) affects approximately one in five persons older than 70 years of age and it is often present in patients with concomitant vascular disease in different body territories (e.g. coronary artery disease). Diagnosis at an early stage is important in order to achieve improvement in patient's symptoms and prognosis. Remarkable improvements in the field of noninvasive and invasive imaging techniques have led to an advanced level the management of patients with PAD. Throughout this review article, the clinically available diagnostic modalities in PAD are presented. Strong and weaker points are stressed out in a manner that elucidates that no perfect diagnostic method exists. Based on the patient's individual profile, as well as on certain aspects of the disease (e.g. morphology of carotid plaque lesions) the attending physician will ultimately decide which diagnostic path will lead to a prompt and correct diagnosis of PAD with the minimum amount of exams and risk for the patient.
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Affiliation(s)
- Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | - Christos Georgakopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Iosif Koutagiar
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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20
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Naka KK, Aboyans V, Vlachopoulos C. Panvascular disease - Diagnosis and management. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 665] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Patel SI, Chakkera HA, Wennberg PW, Liedl DA, Alrabadi F, Cha SS, Hooley DD, Amer H, Wadei HM, Shamoun FE. Peripheral arterial disease preoperatively may predict graft failure and mortality in kidney transplant recipients. Vasc Med 2017; 22:225-230. [DOI: 10.1177/1358863x16689830] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with end-stage renal disease undergoing kidney transplant often have diffuse atherosclerosis and high cardiovascular morbidity and mortality rates. We analyzed the correlation of peripheral arterial disease (PAD), here quantified by an abnormal ankle–brachial index (ABI) measured within the 5 years prior to kidney transplant, with graft failure and mortality rates (primary end points) after adjusting for known cardiovascular risk factors (age, sex, smoking history, hypertension, diabetes, stroke, known coronary artery disease or heart failure, years of dialysis). Of 1055 patients in our transplant population, 819 had arterial studies within the 5 years prior to transplant. Secondary end points included myocardial infarction; cerebrovascular accident; and limb ischemia, gangrene, or amputation. Low ABI was an independent and significant predictor of organ failure (OR, 2.77 (95% CI, 1.68–4.58), p<0.001), secondary end points (HR, 1.39 (95% CI, 0.97–1.99), p<0.076), and death (HR, 1.84 (95% CI, 1.26–2.68), p=0.002). PAD was common in this population: of 819 kidney transplant recipients, 46% had PAD. Low ABI was associated with a threefold greater risk of graft failure, a twofold greater risk of death after transplant, and a threefold greater risk of secondary end points. Screening for PAD is important in this patient population because of the potential impact on long-term outcomes.
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Affiliation(s)
- Salma I Patel
- Department of Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Paul W Wennberg
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - David A Liedl
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Fadi Alrabadi
- Division of Internal Medicine; Abrazo Central Hospital, Phoenix, AZ, USA
| | - Stephen S Cha
- Department of Research Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Darren D Hooley
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Hani M Wadei
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Fadi E Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
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23
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Londero LS, Lindholt JS, Thomsen MD, Hoegh A. Pulse palpation is an effective method for population-based screening to exclude peripheral arterial disease. J Vasc Surg 2016; 63:1305-10. [PMID: 26947795 DOI: 10.1016/j.jvs.2015.11.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a strong association between peripheral arterial disease (PAD) and future cardiovascular events. Therefore, intensive atherosclerotic risk factor reduction is recommended for people with PAD, and early detection is essential. This study assessed whether systematic pedal pulse palpation is an effective screening method for PAD in population-based screening programs. METHODS As part of a randomized screening project, The Viborg Vascular Screening trial, 18,681 men (mean age, 69.3 years; range, 65-74 years) participated in a screening program, which included bilateral pulse palpation and ankle-brachial index (ABI) measurement. PAD was defined as ABI ≤0.9 or ≥1.4. Analysis was conducted on sensitivity, specificity, positive predictive value, and negative predictive value for PAD and for the number of pedal pulses. RESULTS PAD was present in 2215 participants (12.1%). The pedal pulse palpation test was set to be positive for having PAD if one or more pulses were missing. Sensitivity was 71.7% and specificity was 72.3%. No palpable pulses were associated with a 50% chance of ABI-verified PAD or with a false finding. Four palpable pulses were associated with 5% false-negative PAD cases. CONCLUSIONS Pedal pulse palpation is was shown to be a reliable initial screening tool for PAD in population-based programs but only when four pedal pulses were present. Therefore, ABI measurement should routinely be measured in patients with fewer than four palpable pedal pulses so cardiovascular preventive actions can be initiated if PAD is confirmed.
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Affiliation(s)
- Louise S Londero
- Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Department of Cardiovascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark.
| | - Jes S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Department of Cardiovascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark; Departments of Vascular Surgery and Vascular Research Unit, Viborg Hospital, Viborg, Denmark
| | - Marie D Thomsen
- Departments of Vascular Surgery and Vascular Research Unit, Viborg Hospital, Viborg, Denmark
| | - Annette Hoegh
- Departments of Vascular Surgery and Vascular Research Unit, Viborg Hospital, Viborg, Denmark
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Meyborg M, Abdi-Tabari Z, Hoffmeier A, Engelbertz C, Lüders F, Freisinger E, Malyar NM, Martens S, Reinecke H. Outcome of patients with reduced ankle brachial index undergoing open heart surgery with cardiopulmonary bypass. Eur J Cardiothorac Surg 2015; 49:1457-61. [PMID: 26516194 DOI: 10.1093/ejcts/ezv376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/21/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear. METHODS From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI < 0.5, (ii) ABI 0.5-0.69, (iii) ABI 0.7-0.89 or (iv) ABI ≥ 0.9. Follow-up data of 413 (93.2%) patients were analysed with regard to mortality and amputations. RESULTS The groups differed significantly in terms of age, cardiac risk factors, performed cardiac surgery and renal function. Postoperative delayed wound healing was significantly associated with lower ABI (25.9, 15.2, 27.0 and 9.6% in Groups I-IV, respectively, P = 0.003), whereas 30-day mortality was not significantly higher in patients with lower ABI (0, 4.3, 8.1 and 3.9%, respectively, P = 0.4). Kaplan-Meier models showed a significantly lower long-term survival over 4 years in patients with reduced ABI (P = 0.001, long-rank test) while amputations occurred rarely with only one minor amputation in Group II (P = 0.023). CONCLUSIONS Patients with reduced ABIs undergoing heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion.
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Affiliation(s)
- Matthias Meyborg
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Zila Abdi-Tabari
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Hoffmeier
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - Christiane Engelbertz
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Florian Lüders
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Sven Martens
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
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Gefäßerkrankungen und -komplikationen im Rahmen von Herzoperationen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim HL, Seo JB, Chung WY, Zo JH, Kim MA, Kim SH. Prognostic Value of the Ankle-Brachial Index in Patients Undergoing Drug-Eluting Stent Implantation. J Atheroscler Thromb 2015; 22:27-37. [DOI: 10.5551/jat.24406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine
| | - Woo-Young Chung
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine
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Aboyans V, Tanguy B, Desormais I, Bonnet V, Chonchol M, Laskar M, Mohty D, Lacroix P. Prevalence of renal artery disease and its prognostic significance in patients undergoing coronary bypass grafting. Am J Cardiol 2014; 114:1029-34. [PMID: 25150754 DOI: 10.1016/j.amjcard.2014.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/26/2022]
Abstract
Several studies demonstrated the prognostic importance of renal failure and peripheral artery disease in patients undergoing coronary artery bypass grafting (CABG), but data regarding the prognostic value of renal artery disease in this context are scarce. We aimed to study the prevalence and prognostic value of renal artery disease in patients undergoing CABG. We assessed by duplex ultrasound the renal arteries of 429 consecutive patients who underwent CABG, of whom 401 had satisfactory imaging quality to detect >60% renal artery stenosis (RAS) and/or an elevated resistive index (ERI>0.80). Of the 401 subjects included (age 68±10 years, 83% men), 40 (10%) had RAS and 35 (9%) had ERI. Nine patients (2.2%) had both conditions. Patients were followed up for 12.4±7.0 months. The primary outcome was composite, including 30-day death, stroke, and/or myocardial infarction. In a multivariate model adjusted for age, gender, cardiovascular (CV) risk factors, renal function, chronic obstructive pulmonary disease, the use of off-pump CABG, CV co-morbidities, and drugs, the presence of ERI was strongly associated with the occurrence of the composite outcome (odds ratio 4.3, 95% confidence interval 1.7 to 9.9, p=0.0006). Similarly, ERI, not RAS, was significantly associated with the 30-day acute kidney disease and the midterm mortality, as well as fatal and nonfatal CV events. In conclusion, regardless of renal function and other factors, the renal resistive index is a strong predictor of CV and renal events after CABG. Renal duplex ultrasound can identify a subgroup of patients at high risk of CABG.
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Potier L, Roussel R, Labreuche J, Marre M, Cacoub P, Röther J, Wilson PWF, Goto S, Bhatt DL, Steg PG. Interaction between diabetes and a high ankle-brachial index on mortality risk. Eur J Prev Cardiol 2014; 22:615-21. [PMID: 24781202 DOI: 10.1177/2047487314533621] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 04/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Low ankle-brachial index (ABI) is a predictor of increased mortality. The impact of a high ABI on mortality is less studied. Moreover, diabetes is frequently associated with high ABI and, because of specific mechanisms in diabetic vascular diseases, the relationship with prognosis may be unique. Therefore, our aim was to compare mortality in individuals with and without diabetes according to abnormally low and high ABI. DESIGN AND METHODS We studied the association between ABI and all-cause and cardiovascular mortality in 6986 participants from the REACH registry, a cohort of 45 years and older stable outpatients at high cardiovascular risk (2875 (41.1%) with diabetes) followed for 4 years. RESULTS ABI was normal (0.91-1.29) in 49.5%, low (≤0.9) in 47.5%, and high (≥1.3) in 2.9% of participants. During follow up, 9.9% of participants died (6.5% from cardiovascular causes). A low ABI was associated with cardiovascular mortality (adjusted hazard ratio, HR, 1.98, 95% CI 1.62-2.41) and all-cause mortality (HR 2.01, 95% CI 1.72-2.36), without heterogeneity according to diabetes. In contrast, high ABI was associated with higher risk of all-cause mortality in individuals with diabetes (HR 2.11, 95% CI 1.16-3.84), but not without diabetes (HR 0.82, 95% CI 0.36-1.85; p-value for interaction 0.07). The trend was similar for cardiovascular mortality (HR 2.13, 95% CI 1.03-4.44 and HR 1.05, 95% CI 0.43-2.59 with and without diabetes, respectively; p-value for interaction 0.24). CONCLUSIONS In the REACH registry, low ABI was associated with mortality, similarly in individuals without and with diabetes, whereas the association with high ABI was only observed in patients with diabetes.
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Affiliation(s)
- Louis Potier
- Diabetology, Hôpital Bichat, and Département Hospitalo-Universitaire FIRE, AP-HP, Paris, France INSERM U1138, Research Center les Cordeliers, Paris, France Paris Diderot University, Paris, France
| | - Ronan Roussel
- Diabetology, Hôpital Bichat, and Département Hospitalo-Universitaire FIRE, AP-HP, Paris, France INSERM U1138, Research Center les Cordeliers, Paris, France Paris Diderot University, Paris, France
| | - Julien Labreuche
- Paris Diderot University, Paris, France INSERM U1148, Paris, France
| | - Michel Marre
- Diabetology, Hôpital Bichat, and Département Hospitalo-Universitaire FIRE, AP-HP, Paris, France Paris Diderot University, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | - Peter W F Wilson
- Atlanta VA Medical Center and Cardiology Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Deepak L Bhatt
- Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Philippe Gabriel Steg
- Paris Diderot University, Paris, France INSERM U1148, Paris, France Cardiology, Hôpital Bichat, and Département Hospitalo-Universitaire FIRE, AP-HP, Paris, France NHLI, Imperial College, Royal Brompton Hospital, London, UK
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Furuhashi T, Moroi M, Awaya T, Minakawa M, Masai H, Kunimasa T, Fukuda H. Usefulness of Stress Myocardial Perfusion Imaging and Baseline Clinical Factors for Predicting Cardiovascular Events in Patients With Prior Coronary Artery Disease. Circ J 2014; 78:1676-83. [DOI: 10.1253/circj.cj-14-0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Toru Awaya
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Megumi Minakawa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hirofumi Masai
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Taeko Kunimasa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hiroshi Fukuda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Papa EDE, Helber I, Ehrlichmann MR, Alves CMR, Makdisse M, Matos LN, Borges JL, Lopes RD, Stefanini E, Carvalho AC. Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography. Clinics (Sao Paulo) 2013; 68:1481-7. [PMID: 24473504 PMCID: PMC3840368 DOI: 10.6061/clinics/2013(12)02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/08/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease. METHODS We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease. RESULTS The patients' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold. CONCLUSION In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events.
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Affiliation(s)
- Eduardo D E Papa
- Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil
| | - Izo Helber
- Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil
| | - Manes R Ehrlichmann
- Departamento de Cardiologia, Hospital Israelita Albert Einstein, São PauloSP, Brazil
| | | | - Marcia Makdisse
- Departamento de Cardiologia, Hospital Israelita Albert Einstein, São PauloSP, Brazil
| | - Livia N Matos
- Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil
| | - Jairo Lins Borges
- Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil
| | - Renato D Lopes
- Department of Medicine, Duke University School of Medicine, DurhamNorth Carolina, USA
| | - Edson Stefanini
- Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil
| | - Antonio Carlos Carvalho
- Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil
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Lee JY, Lee SW, Lee WS, Han S, Park YK, Kwon CH, Jang JY, Cho YR, Park GM, Ahn JM, Kim WJ, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Prevalence and Clinical Implications of Newly Revealed, Asymptomatic Abnormal Ankle-Brachial Index in Patients With Significant Coronary Artery Disease. JACC Cardiovasc Interv 2013; 6:1303-13. [DOI: 10.1016/j.jcin.2013.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/14/2013] [Indexed: 11/25/2022]
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Sumin AN, Gaifullin RA, Bezdenezhnykh AV, Korok EV, Karpovich AV, Ivanov SV, Barbarash OL, Barbarash LS. PREVALENCE OF MULTI-FOCAL ATHEROSCLEROTIC PATHOLOGY ACROSS AGE GROUPS. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-2-63-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To compare the prevalence of multi-focal subclinical atherosclerotic pathology and its determinants in cardiovascular surgery patients.Material and methods. The study included 1018 patients — 825 en and 193 women (mean age 59,0±12,0 years) — who were hospitalised for a planned intervention on coronary or other arteries. Group I (n=542) was aged under 60 years, Group II (n=215) — 60–64 years, Group III (n=141) — 65–69 years, and Group IV (n=120) — 70 years or older. All participants underwent coronary angiography and Doppler ultrasound; peripheral angiography was performed, if necessary. Multi-focal atherosclerosis (MFA) criteria were the presence of stenosis (≥30%) or revascularisation in two or more vascular territories.Results. Subclinical atherosclerotic pathology of various localisation was observed in 52,3% of the patients. Advanced age was linked to an increase in the MFA prevalence: from 45,8% in Group I to 58,6% in Group II, 58,2% in Group III, and 63,3% in Group IV (p=0,0001). In Group I, MFA was associated with the intermittent claudication syndrome (ICS), decreased body mass index (BMI), increased intima-media thickness (IMT), elevated total cholesterol (TCH). However, in Groups II–IV, the only association observed was between MFA and ICS.Conclusion. Taking into account the subclinical (hemodynamically insignificant) arterial pathology had resulted in a high prevalence of MFA. Advanced age was associated with a higher MFA prevalence. Other factors linked to MFA were increased IMT, elevated TCH, decreased BMI, and ICS.
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Chung PW, Kim DH, Kim HY, Park KY, Park TH, Hong JM, Kim GM, Bang OY, Oh K, Lee SJ. Differences of ankle-brachial index according to ischemic stroke subtypes: the peripheral artery disease in Korean patients with ischemic stroke (PIPE) study. Eur Neurol 2012; 69:179-84. [PMID: 23296209 DOI: 10.1159/000342892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/06/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Although previous studies showed a high prevalence of abnormal ankle-brachial index (ABI) in patients with ischemic stroke, few data exist regarding ABI in Asian patients with ischemic stroke. The purpose of the present study was to determine the prevalence and factors associated with abnormal ABI (≤0.9) in a cohort of ischemic stroke patients. METHODS In this prospective multicenter study, 1,293 patients diagnosed with acute ischemic stroke or transient ischemic attack underwent ABI measurement to evaluate an association between abnormal ABI and vascular risk factors and clinical characteristics. Differences in ABI by stroke subtypes were also assessed. RESULTS Abnormal ABI of ≤0.9 was found in 13.0%. Patients with abnormal ABI were more likely to be older and had higher initial stroke severity. The prevalence of abnormal ABI was 18.4% in large artery atherosclerosis, 7% in small artery disease, and 19.2% in cardioembolism (p < 0.001). Multiple logistic regression analysis showed that age, hyperlipidemia, diabetes, and large artery atherosclerosis subtype were independent factors associated with abnormal ABI. CONCLUSIONS These data suggest that the prevalence of abnormal ABI in Korean patients with ischemic stroke was lower than that in Caucasian patients, which might be associated with ethnic differences in underlying stroke subtypes.
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Affiliation(s)
- Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FGR, Hiatt WR, Jönsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux PM, Stoffers HEJ, Treat-Jacobson D. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126:2890-909. [PMID: 23159553 DOI: 10.1161/cir.0b013e318276fbcb] [Citation(s) in RCA: 1076] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bouisset F, Bongard V, Ruidavets JB, Hascoët S, Taraszkiewicz D, Roncalli J, Carrié D, Galinier M, Elbaz M, Ferrières J. Prognostic usefulness of clinical and subclinical peripheral arterial disease in men with stable coronary heart disease. Am J Cardiol 2012; 110:197-202. [PMID: 22513182 DOI: 10.1016/j.amjcard.2012.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 03/03/2012] [Accepted: 03/03/2012] [Indexed: 11/20/2022]
Abstract
The prognostic value of symptomatic peripheral arterial disease (PAD) in patients with coronary heart disease (CHD) is well documented, but few reports differentiating between symptomatic and asymptomatic forms of PAD are available. We investigated the respective prognostic effect of clinical and subclinical PAD on long-term all-cause mortality in patients with stable CHD. We analyzed 710 patients with stable CHD referred for hospitalization for CHD evaluation and management. As a part of the study, they completed questionnaires on medical history, underwent a standardized clinical examination, including ankle-brachial index (ABI) measurement, and provided a fasting blood sample. Three groups of patients were individualized: no PAD (no history of PAD and ABI >0.9 but ≤1.4); subclinical PAD (no history of PAD but abnormal ABI [i.e., ≤0.9 or >1.4); and clinical PAD (history of claudication, peripheral arterial surgery, or amputation due to PAD). Clinical and subclinical PAD was present in 83 (11.7%) and 181 (25.5%) patients, respectively. After a median follow-up of 7.2 years, 130 patients died. On multivariate analysis adjusted for age, hypertension, diabetes, dyslipidemia, smoking, left ventricular ejection fraction, CHD duration, heart rate, history of stroke or transient ischemic attack, and coronary revascularization, previous clinical PAD (hazard ratio 2.11, 95% confidence interval 1.28 to 3.47) and subclinical PAD (hazard ratio 1.65, 95% confidence interval 1.11 to 2.44) were significantly associated with increased all-cause mortality. In conclusion, our study has demonstrated that the detection of subclinical PAD by ABI in patients with stable CHD provides additional information for long-term mortality risk evaluation.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France
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Pasqualini L, Schillaci G, Pirro M, Vaudo G, Leli C, Colella R, Innocente S, Ciuffetti G, Mannarino E. Prognostic value of low and high ankle-brachial index in hospitalized medical patients. Eur J Intern Med 2012; 23:240-4. [PMID: 22385881 DOI: 10.1016/j.ejim.2011.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/03/2011] [Accepted: 09/02/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is frequently underdiagnosed in the clinical practice, leading to a lack of opportunity to detect subjects at a high risk for cardiovascular (CV) death. The ankle-brachial pressure index (ABI) represents a noninvasive, objective tool to diagnose PAD and to predict adverse outcome. METHODS ABI was determined by means of Doppler velocimetry, in 707 patients, aged 50 years or older, consecutively hospitalized in an internal medicine ward, who were followed-up for at least 12 months in order to assess all-cause and CV mortality. RESULTS Symptomatic PAD affected 8% of the population while the prevalence of PAD, defined as ABI <0.90, was 29%; high ABI (>1.40) was found in 8% of the patients. After a mean follow-up period of 1.6 years, both low and high ABI were independently associated with CV mortality with a hazard ratio of 1.99 (p=0.016) for low and 2.13 (p=0.04) for high ABI, compared with normal ABI (0.90-1.40). High ABI also independently predicted all-cause mortality with a hazard ratio of 1.77 (p=0.04). DISCUSSION ABI measurement reveals a large number of individuals with asymptomatic PAD among those hospitalized in an internal medicine department. An increased mortality was observed in patients with both low and high ABI. Hospital admission for any reason may serve as an opportunity to detect PAD and start appropriate preventive actions.
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Affiliation(s)
- Leonella Pasqualini
- Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy.
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Guía de práctica clíníca de la ESC sobre diagnóstico y tratamiento de las enfermedades arteriales periféricas. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2011.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Lafitte M, Pucheu Y, Latry K, Dijos M, Casassus E, Couffinhal T. Predictors of cardiovascular prognosis in patients receiving optimized secondary prevention measures after acute coronary syndrome. Eur J Prev Cardiol 2012; 20:283-90. [DOI: 10.1177/2047487311434107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marianne Lafitte
- CHU de Bordeaux, Centre d’Exploration, de Prévention et de Traitement de l’Athéroclérose (CEPTA), Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France
- University of Bordeaux, F-33000 Bordeaux, France
| | - Yann Pucheu
- CHU de Bordeaux, Centre d’Exploration, de Prévention et de Traitement de l’Athéroclérose (CEPTA), Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France
- University of Bordeaux, F-33000 Bordeaux, France
| | - Karin Latry
- CHU de Bordeaux, Centre d’Exploration, de Prévention et de Traitement de l’Athéroclérose (CEPTA), Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France
- University of Bordeaux, F-33000 Bordeaux, France
- INSERM, Adaptation cardiovasculaire à l’ischémie, U1034, F-33600 Pessac, France
| | - Marina Dijos
- CHU de Bordeaux, Centre d’Exploration, de Prévention et de Traitement de l’Athéroclérose (CEPTA), Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France
- University of Bordeaux, F-33000 Bordeaux, France
| | - Eléonore Casassus
- CHU de Bordeaux, Centre d’Exploration, de Prévention et de Traitement de l’Athéroclérose (CEPTA), Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France
- University of Bordeaux, F-33000 Bordeaux, France
| | - Thierry Couffinhal
- CHU de Bordeaux, Centre d’Exploration, de Prévention et de Traitement de l’Athéroclérose (CEPTA), Hôpital Cardiologique du Haut-Lévêque, F-33000 Bordeaux, France
- University of Bordeaux, F-33000 Bordeaux, France
- INSERM, Adaptation cardiovasculaire à l’ischémie, U1034, F-33600 Pessac, France
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Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FGR, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:2851-906. [PMID: 21873417 DOI: 10.1093/eurheartj/ehr211] [Citation(s) in RCA: 1049] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
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- 3rd Division of Cardiology, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland.
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Cournot M, Bura A, Cambou JP, Taraszkiewicz D, Maloizel J, Galinier M, Broutin HH, Chamontin B, Carrié D, Ferrieres J. Arterial Ultrasound Screening as a Tool for Coronary Risk Assessment in Asymptomatic Men and Women. Angiology 2011; 63:282-8. [DOI: 10.1177/0003319711414865] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the imaging tests most commonly used to assess cardiovascular diseases (CVDs) in daily practice is Doppler ultrasonography of the carotid and femoral arteries. We included 2709 participants with no history or symptoms of CVD; they had a risk factor assessment and a carotid and femoral ultrasonography at baseline. Incident cases of definite coronary events were recorded during a median follow-up of 6 years. Approximately, 63% of the sample presented abnormalities (carotid stenosis >50%, carotid plaque, femoral plaque, increased intima–media thickness [IMT]). A moderately increased IMT (>0.63 mm) or the presence of carotid or femoral artery plaque was related to prognosis. The associations persisted after adjustment for pretest risk, treatment with statins, and other Doppler ultrasonography abnormalities. The hazard ratio increased significantly with the number of abnormalities (varying from 2.35 [1.16-4.74] to 14.83 [6.47-33.9]).
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Affiliation(s)
- Maxime Cournot
- Department of cardiology, Centre Hospitalier du Val d’Ariège, Foix, France
| | - Alessandra Bura
- Department of Vascular Medicine, CHU Rangueil, Toulouse, France
- INSERM U858, Toulouse, France
| | | | | | - Julie Maloizel
- Department of Vascular Medicine, CHU Rangueil, Toulouse, France
| | | | | | - Bernard Chamontin
- Department of Internal Medicine and Hypertension, CHU Rangueil, Toulouse, France
| | - Didier Carrié
- Preventive Cardiology Unit, CHU Rangueil, Toulouse, France
| | - Jean Ferrieres
- Preventive Cardiology Unit, CHU Rangueil, Toulouse, France
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Combination of ankle brachial index and diabetes mellitus to predict cardiovascular events and mortality after an acute coronary syndrome. Int J Cardiol 2011; 151:84-8. [DOI: 10.1016/j.ijcard.2010.04.097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 04/29/2010] [Indexed: 11/23/2022]
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43
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Vodnala D, Rajagopalan S, Brook RD. Medical Management of the Patient with Intermittent Claudication. Cardiol Clin 2011; 29:363-79. [DOI: 10.1016/j.ccl.2011.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Aboyans V, Lacroix P, Tran MH, Salamagne C, Galinat S, Archambeaud F, Criqui MH, Laskar M. The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease. J Vasc Surg 2011; 53:984-91. [DOI: 10.1016/j.jvs.2010.10.054] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 11/24/2022]
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45
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Risk of death and myocardial infarction in patients with peripheral arterial disease undergoing percutaneous coronary intervention (from the National Heart, Lung and Blood Institute Dynamic Registry). Am J Cardiol 2011; 107:959-64. [PMID: 21256469 DOI: 10.1016/j.amjcard.2010.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/21/2010] [Accepted: 11/21/2010] [Indexed: 01/24/2023]
Abstract
Patients with peripheral arterial disease (PAD) undergoing percutaneous coronary intervention (PCI) are at high risk for adverse cardiovascular events. Trends over time in outcomes with advances in PCI and medical therapy are unknown. We evaluated 866 patients with PAD in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry undergoing PCI according to treatment eras: the early bare metal stent (BMS) era (wave 1, 1997 to 1998, n = 180), the BMS era (waves 2 and 3, 1999 and 2001 to 2002, n = 339), and the drug-eluting stent (DES) era (waves 4 and 5, 2004 and 2006, n = 347). We compared in-hospital and 1-year outcomes by recruitment era. In-hospital coronary artery bypass graft surgery rates were significantly lower in the later eras (3.9%, 0.9%, and 0.6% for the early BMS, BMS, and DES eras, respectively, p for trend = 0.005), and an increasing percentage of patients were discharged on aspirin, β blockers, statins, and thienopyridines (p for trend <0.001 for all comparisons). Cumulative 1-year event rates in patients with PAD in the early BMS era, BMS era, and DES era for death were 13.7%, 10.5%, and 9.8% (p for trend = 0.21), those for myocardial infarction (MI) were 9.8%, 8.8%, and 10.0% (p for trend = 0.95), and those for repeat revascularization were 26.8%, 21.0%, and 17.2% (p for trend = 0.008). The 1-year adjusted hazard ratios of adverse events in patients with PAD using the early BMS era as the reference were 0.84 for death in the BMS era (95% confidence interval [CI] 0.46 to 1.55, p = 0.58) and 1.35 in the DES era (95% CI 0.71 to 2.56, p = 0.36), 0.89 for MI in the BMS era (95% CI 0.48 to 1.66, p = 0.72) and 1.02 in the DES era (95% CI 0.55 to 1.87, p = 0.95), and 0.63 for repeat revascularization in the BMS era (95% CI 0.41 to 0.97, p = 0.04) and 0.46 in the DES era (95% CI 0.29 to 0.73, p = 0.001). In conclusion, despite significant improvements in medical therapy and a decrease in repeat revascularization over time, patients with PAD who undergo PCI have a persistent high rate of death and MI.
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Hietanen HJ, Pääkkönen R, Salomaa V. Ankle blood pressure and pulse pressure as predictors of cerebrovascular morbidity and mortality in a prospective follow-up study. Stroke Res Treat 2011; 2010:729391. [PMID: 21318164 PMCID: PMC3026983 DOI: 10.4061/2010/729391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 11/24/2010] [Accepted: 12/23/2010] [Indexed: 11/20/2022] Open
Abstract
Background and Objective. We examined the association of elevated ankle blood pressure (ABP), together with exercise blood pressure, with incident cerebrovascular (CV) morbidity and mortality in a prospective follow-up study of 3,808 patients. The results were compared with pulse pressure, another indicator of arterial stiffness. Methods. Patients with normal ankle and exercise brachial blood pressures were taken as the reference group. Pulse pressure was considered as quartiles with the lowest quartile as the reference category. Results. A total of 170 subjects had a CV event during the follow-up. Multivariate adjusted hazard ratio of a CV event was 2.24 (95% CI 1.43–3.52, P < .0001) in patients with abnormal ABP. The pulse pressure was significant only in the model adjusted for age and sex. Conclusion. The risk of a future CV event was elevated already in those patients among whom elevated ABP was the only abnormal finding. As a risk marker, ABP is superior to the pulse pressure.
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Affiliation(s)
- Heikki J Hietanen
- Department of Clinical Physiology, Helsinki Deaconess Institute, Alppikatu 2, 00530 Helsinki, Finland
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Different prognostic value of silent peripheral artery disease in type 2 diabetic and non-diabetic subjects with stable cardiovascular disease. Atherosclerosis 2011; 214:191-5. [DOI: 10.1016/j.atherosclerosis.2010.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 10/13/2010] [Accepted: 10/14/2010] [Indexed: 11/18/2022]
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Frank M, Aboyans V, Le Guyader A, Orsel I, Lacroix P, Cornu E, Laskar M. Usefulness of postoperative heart rate as an independent predictor of mortality after coronary bypass grafting. Am J Cardiol 2010; 106:958-62. [PMID: 20854957 DOI: 10.1016/j.amjcard.2010.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 11/16/2022]
Abstract
Heart rate (HR) predicts mortality and cardiovascular events in the general population and in patients with coronary artery disease. However, little evidence is available for patients after coronary revascularization. The aim of this study was to assess the prognostic value of ambulatory postoperative HR after coronary artery bypass grafting. Data from a prospective cohort study enrolling patients who underwent nonurgent coronary artery bypass grafting from 1998 to 2002 were analyzed. Baseline postoperative HR was measured 2 months after surgery, and patients were followed annually thereafter. The primary outcome was all-cause mortality. The secondary outcome combined any of the following events: death, nonfatal acute coronary syndromes, stroke or transient ischemic attack, secondary coronary revascularization, or vascular surgery. Seven hundred ninety-four patients (mean age 65.8 ± 9.3 years) were eligible for follow-up, predominantly men (84.1%). The mean follow-up duration was 3.2 ± 1.3 years, during which 40 patients (5.0%) died. In the univariate analysis, HR >90 beats/min was significantly associated with all outcomes. After adjustments for major confounding factors and the use of β blockers, postoperative HR >90 beats/min remained significantly associated with the secondary outcome (hazard ratio 2.26, 95% confidence interval 1.04 to 4.91, p = 0.04). Association of postoperative HR >90 beats/min with all-cause mortality was only borderline in the multivariate analysis (hazard ratio 3.57, 95% confidence interval 0.90 to 14.17, p = 0.07), because of the limited sample population size. In conclusion, postoperative HR >90 beats/min may be associated with poor prognoses in patients with coronary artery disease, even after surgical revascularization.
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Affiliation(s)
- Michael Frank
- Department of Thoracic and Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France.
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Are Toe Pressures Measured by a Portable Photophlethysmograph Equivalent to Standard Laboratory Tests? J Wound Ostomy Continence Nurs 2010; 37:475-86. [DOI: 10.1097/won.0b013e3181eda0c5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Cassar A, Poldermans D, Rihal CS, Gersh BJ. The management of combined coronary artery disease and peripheral vascular disease. Eur Heart J 2010; 31:1565-72. [DOI: 10.1093/eurheartj/ehq186] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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