Impact of Guideline-Directed Medical Therapy on 10-Year Mortality after Revascularization for Patients with Chronic Limb-Threatening Ischemia

Autor: Yosuke, Hata, Osamu, Iida, Shin, Okamoto, Takayuki, Ishihara, Kiyonori, Nanto, Takuya, Tsujimura, Naoko, Higashino, Taku, Toyoshima, Ikurou, Kitano, Yoshihiko, Tsuji, Mitsuyoshi, Takahara, Toshiaki, Mano
Rok vydání: 2023
Předmět:
Zdroj: Journal of Atherosclerosis and Thrombosis. 30:663-674
ISSN: 1880-3873
1340-3478
DOI: 10.5551/jat.63773
Popis: This study aimed to investigate the long-term impact of guideline-directed medical therapy (GDMT) on 10-year mortality in patients with chronic limb-threatening ischaemia (CLTI) after revascularization.We performed a retrospective multicentre study enrolle 459 patients with CLTI who underwent revascularization (396 endovascular therapy [EVT] and 63 bypass surgery [BSX] cases) between January 2007 and December 2011. The primary outcome measure was all-cause mortality. We additionally explored the predictors for all-cause mortality using Cox regression hazard models; the influence of GDMT, defined as prescription of antiplatelet agents, statins, and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in aggregate, on all-cause mortality, and the association between baseline characteristics using interaction effects.During the 10-year follow-up after revascularization, 234 patients died. In Kaplan-Meier analysis, 10-year mortality was significantly lower in patients who received statins (p＜.001) and ACE inhibitors or ARBs (p=.010) than those who did not. However, there were no differences in 10-year mortality between patients who received anti-platelet agents and those who did not (p=.62). Interaction analysis revealed that GDMT had a significantly different hazard ratio in patients who were and were not on hemodialysis and in those treated with EVT or BSX (p for interaction =.002 and .044, respectively). In the multivariate analysis, age ＞75 years, non-ambulatory status, hemodialysis, congestive heart failure, left ventricular ejection fraction ＜50%, and GDMT were significantly associated with all-cause mortality.Appropriate GDMT use was independently associated with 10-year mortality in patients with CLTI after revascularization.
Databáze: OpenAIRE
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