One in 10 Patients Hospitalized With Adverse Limb Events Within 1 Year of Peripheral Artery Revascularization

August 23, 2018—Data published by Connie N. Hess, MD, et al show that patients with peripheral artery disease (PAD) who undergo revascularization are at risk for subsequent adverse events. The article was published in Journal of the American College of Cardiology (JACC; 2018;72:999–1011).

As summarized in JACC, researchers evaluated 381,415 patients in the Premier Healthcare Database who underwent peripheral artery revascularization between January 1, 2009 and September 30, 2014. The primary outcome examined was 1-year hospitalization rates related to major adverse limb events (MALEs).

Within 1 year of revascularization, investigators reported that 10,182 (10.3%) patients had been hospitalized related to MALEs.

Secondary outcomes also studied included 1-year outpatient endovascular revascularization (n = 42,056; 11%) and limb-related (n = 71,663; 18.8%), cardiovascular (n = 48,875; 12.8%), and all-cause inpatient hospitalizations (n = 148,457; 38.9%). During the study period, researchers observed a decrease in limb-related, cardiovascular, and all-cause hospitalizations, but rates of outpatient endovascular revascularization increased.

“These data demonstrate the residual risk for limb and cardiac ischemic events that exist after peripheral revascularization, even for those 'low-risk' procedures performed for claudication,” said Dr. Hess in comments to Endovascular Today. “Furthermore, we identified risk factors for MALE, some of which may be modifiable, and we showed that underuse of guideline-recommended therapies, such as statins, in PAD patients remains a problem.”

Several patient characteristics significantly associated with an increased risk of hospitalization with MALE included male sex, African-American race, Medicare and Medicaid insurance, diabetes, renal insufficiency, heart failure, history of tobacco use, baseline critical or acute limb ischemia, surgical revascularization, and noncardiology operator specialty.

“The PAD population has been underdiagnosed, undertreated, and understudied,” commented Dr. Hess. “Our study illustrates the burden of disease in a contemporary practice population of PAD patients treated with revascularization and highlights unmet needs in treating these patients."

“Our findings may help in the design of future clinical trials. Understanding the current use of peripheral revascularization procedures could help to identify target populations for trials, and cardiac and limb event rates observed in practice could be used in determining sample size calculation.” Dr. Hess concluded.