Postoperative outcomes for patients undergoing elective revascularization for critical limb ischemia and intermittent claudication: A subanalysis of the Coronary Artery Revascularization Prophylaxis (CARP) trial
| Autor: | Steven M. Santilli, Fred N. Littooy, Thomas E. Moritz, Edward O. McFalls, Amritha Raghunathan, William C. Krupski, Herbert B. Ward, Lizy Thottapurathu, Joseph H. Rapp |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Disease Revascularization Coronary artery disease Ischemia Internal medicine medicine Humans Myocardial infarction Prospective Studies Cardiac catheterization Aged Proportional Hazards Models Peripheral Vascular Diseases Leg Chi-Square Distribution business.industry Critical limb ischemia Perioperative Intermittent Claudication Middle Aged medicine.disease Survival Analysis Intermittent claudication Surgery Treatment Outcome Cardiology Female medicine.symptom business Claudication Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of Vascular Surgery. 43(6):1175-1182 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2005.12.069 |
| Popis: | To determine the perioperative mortality, myocardial infarction rate, and long-term survival of patients with critical limb ischemia (CLI) compared with those with intermittent claudication (IC) within a cohort selected for significant coronary artery disease, a secondary analysis was conducted of a prospective, randomized, multicenter trial of Coronary Artery Revascularization Prophylaxis (CARP) before peripheral vascular surgery. This multicenter trial was sponsored by the Cooperative Studies Program of the Department of Veterans Affairs.Of the 510 patients enrolled in the CARP trial and randomized to coronary revascularization or no revascularization before elective vascular surgery, 143 had CLI and 164 had IC as an indication for lower limb revascularization;95% of each group were men. The presence of coronary artery disease was determined by cardiac catheterization. Eligible patients had at least one treatable coronary lesion ofor =70%. Those with significant left main disease, ejection fraction of20%, and aortic stenosis were excluded. Patients were randomized to coronary artery disease revascularization or no revascularization before vascular surgery and followed for mortality and morbidity perioperatively and for a median of 2.7 years postoperatively. Medical treatment of coronary artery disease was pursued aggressively.Patients with IC had a longer time from randomization to vascular surgery (p = .001) and more abdominal operations (p.001). Patients with CLI had more urgent operations (p = .006), reoperations (p.001), and limb loss (p = .008) as well as longer hospital stays (p.001). The IC group had more perioperative myocardial infarctions (CLI, 8.4%; IC, 17.1%; p = .024), although perioperative mortality was similar (CLI, 3.5%; IC, 1.8%; p = .360). In follow-up, the IC group also had numerically more myocardial infarctions (CLI, 16.8%; IC, 25%; p = .079), but mortality was not different (CLI, 21%; IC, 22%; p = .825). Coronary artery revascularization did not lower perioperative or long-term mortality in either group.Our data indicate that patients with significant coronary artery disease and either CLI or IC can undergo vascular surgery with low mortality and morbidity, and these results are not improved by coronary artery revascularization before vascular surgery. Furthermore, when selected for the presence of symptomatically stable, severe coronary artery disease, there is no difference in long-term survival between patients with CLI and IC. Finally, the better-than-predicted outcomes for these patients with advanced systemic atherosclerosis may be due to aggressive medical management with beta-blockers, statins, and acetylsalicylic acid. |
| Databáze: | OpenAIRE |
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