Acute Limb Ischemia in Peripheral Artery Disease

• DOI: 10.1161/circulationaha.119.039773
• Publication Date: 2019-06-26T09:00:18Z
• Authors: Connie N. Hess; Zhen Huang; Manesh R. Patel; Iris Baumgartner; Jeffrey S. Berger; Juuso I. Blomster; F. Gerry R. Fowkes; Peter Held; W. Schuyler Jones; Brian Katona; Kenneth W. Mahaffey; Lars Norgren; Frank W. Rockhold; William R. Hiatt
• Keywords: Stroke

Background: Acute limb ischemia (ALI) is an important clinical event and emerging cardiovascular trial outcome. Risk factors for outcomes after ALI have not been fully evaluated. Methods: EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized patients with peripheral artery disease to ticagrelor versus clopidogrel. Enrollment criteria included ankle-brachial index ≤0.80 or previous lower extremity revascularization. Patients were grouped according the primary outcome, postrandomization hospitalization. Baseline associated identified using Cox proportional hazards modeling. Models hospitalization as a time-dependent covariate developed secondary major adverse events (myocardial infarction, death, ischemic stroke), all-cause mortality, amputation. Results: Among 13 885 patients, 1.7% (n=232) had 293 hospitalizations (0.8 per 100 patient-years). without younger more often revascularization baseline index. Treatment during endovascular (39.2%, n=115), surgical bypass (24.6%, n=72), amputation (13.0%, n=38). After multivariable adjustment, any (Hazard Ratio [HR] 4.7, 95% CI 3.3–6.8, P <0.01), atrial fibrillation (HR 1.8, 1.1–3.2, =0.03), ≤0.60 1.3 0.10 decrease, 1.1–1.5, <0.01) higher risk. Older age 0.8 10-year increase, 0.7–1.0, =0.02) statin use 0.7, 0.5–0.9, risk ALI. There was no relationship between treatment clopidogrel revascularization, procedures performed than 6 months prior (adjusted HR 2.63, 1.75–3.96). In overall population, subsequent MACE 1.4, 1.0–2.1, =0.04), mortality 3.3, 2.4–4.6, 34.2, 9.7–20.8, <0.01). Conclusions: Previous fibrillation, identify at heightened ALI, limb-related morbidity mortality. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01732822.