Association of Changes in Perfusion and Clinical Outcomes Analyzed in Revascularization for CLI
September 6, 2017—Tarek A. Hammad, MD, et al conducted an investigation to quantify changes in ankle and toe pressure from pre- to postendovascular revascularization for critical limb ischemia (CLI) and examine their association with major adverse limb events (MALEs; defined as target limb revascularization, amputation, or death). The findings from this analysis of the IN.PACT DEEP trial are available online ahead of print in Catheterization and Cardiovascular Interventions.
Among the 358 patients with CLI from the international multicenter IN.PACT DEEP trial, ankle and toe pressure measurements were available at both baseline and after intervention in 270 and 44 patients, respectively. The change in ankle and toe pressures in response to endovascular revascularization and the association with 1-year MALEs were examined using Kaplan-Meier curves and multivariable Cox proportional hazard analyses. Corresponding optimal cutoff points were also identified.
As summarized in Catheterization and Cardiovascular Interventions, the investigators found that the mean increase in ankle and toe pressures following revascularization was 33 and 13 mm Hg, respectively. Patients with an improvement of ankle pressure > 73 mm Hg or toe pressure > 1 mm Hg similarly had the lowest incidence of MALEs (23%), whereas the highest rate of MALEs (50%) was found in those whose toe pressure failed to improve by at least 1 mm Hg following intervention. In addition, an increase in ankle pressure > 73 mm Hg was numerically protective against MALEs, and more importantly, an increase in toe pressure of > 1 mm Hg provided statistically significant protection from MALEs (adjusted hazard ratio, 0.15; 95% confidence interval, 0.04–0.57; P = .005).
Improvements in toe pressure after revascularization are incremental and rarely normalize, and toe pressure, compared to ankle pressure, is more useful in CLI and predicts future MALEs, concluded the investigators in Catheterization and Cardiovascular Interventions.