TY - JOUR
T1 - Fate of individuals with ischemic amputations in the REACH Registry
T2 - Three-year cardiovascular and limb-related outcomes
AU - Abola, Maria Teresa B.
AU - Bhatt, Deepak L.
AU - Duval, Sue
AU - Cacoub, Patrice P.
AU - Baumgartner, Iris
AU - Keo, Hong
AU - Creager, Mark A.
AU - Brennan, Danielle M.
AU - Steg, Ph Gabriel
AU - Hirsch, Alan T
N1 - Funding Information:
Dr Creager has received a research grant from Sanofi-Aventis and consulting fees from AstraZeneca, Genzyme, Merck, and Vasogen.
PY - 2012/4
Y1 - 2012/4
N2 - Objective: To evaluate systemic and limb ischemic event rates of PAD patients with prior leg amputation and determine predictors of adverse outcomes. Methods: The REduction of Atherothrombosis for Continued Health (REACH) Registry provided a prospective multinational cohort of 7996 outpatients with PAD enrolled from primary medical clinics in 44 countries in 2003-2004. 1160 patients (14.5%) had a prior leg amputation at any level. Systemic (myocardial infarction [MI], stroke, cardiovascular death) and limb (angioplasty, surgery, amputation) ischemic event rates were determined in a 3-year follow-up. Results: PAD patients with leg amputations on entry had a 5-fold higher rate of a subsequent amputation (12.4% vs. 2.4%, P<.001), lower rate of peripheral angioplasty (8.3% vs. 10.7%, P=.005), and similar rates of surgical revascularization procedures compared with PAD patients without amputation. A nearly 2-fold increase in rates of cardiovascular death (14.5% vs. 7.7%, P<.001) and all-cause mortality (21.8% vs. 12.6%, P<.001) and an increase in the composite outcome of MI, stroke, cardiovascular death, or hospitalization (48.7% vs. 40.0%, P<.001) were noted. Recent (≤1 year) amputation was associated with higher rates of worsening PAD, subsequent lower extremity surgical revascularization procedures, re-amputation, non-fatal MI, and the composite outcome, including hospitalization. Adverse systemic and limb ischemic outcomes were similar regardless of amputation level. Conclusions: Individuals with a history of leg amputations have markedly elevated rates of systemic and limb-related outcomes. PAD patients with recent ischemic amputation have the highest risk of adverse events. A history of " minor" ischemic amputation may confer an identical systemic risk as " major" leg amputation.
AB - Objective: To evaluate systemic and limb ischemic event rates of PAD patients with prior leg amputation and determine predictors of adverse outcomes. Methods: The REduction of Atherothrombosis for Continued Health (REACH) Registry provided a prospective multinational cohort of 7996 outpatients with PAD enrolled from primary medical clinics in 44 countries in 2003-2004. 1160 patients (14.5%) had a prior leg amputation at any level. Systemic (myocardial infarction [MI], stroke, cardiovascular death) and limb (angioplasty, surgery, amputation) ischemic event rates were determined in a 3-year follow-up. Results: PAD patients with leg amputations on entry had a 5-fold higher rate of a subsequent amputation (12.4% vs. 2.4%, P<.001), lower rate of peripheral angioplasty (8.3% vs. 10.7%, P=.005), and similar rates of surgical revascularization procedures compared with PAD patients without amputation. A nearly 2-fold increase in rates of cardiovascular death (14.5% vs. 7.7%, P<.001) and all-cause mortality (21.8% vs. 12.6%, P<.001) and an increase in the composite outcome of MI, stroke, cardiovascular death, or hospitalization (48.7% vs. 40.0%, P<.001) were noted. Recent (≤1 year) amputation was associated with higher rates of worsening PAD, subsequent lower extremity surgical revascularization procedures, re-amputation, non-fatal MI, and the composite outcome, including hospitalization. Adverse systemic and limb ischemic outcomes were similar regardless of amputation level. Conclusions: Individuals with a history of leg amputations have markedly elevated rates of systemic and limb-related outcomes. PAD patients with recent ischemic amputation have the highest risk of adverse events. A history of " minor" ischemic amputation may confer an identical systemic risk as " major" leg amputation.
KW - Amputation
KW - Atherosclerosis
KW - Critical limb ischemia
KW - Health outcomes
KW - Myocardial infarction
KW - Peripheral artery disease
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U2 - 10.1016/j.atherosclerosis.2012.01.002
DO - 10.1016/j.atherosclerosis.2012.01.002
M3 - Article
C2 - 22321872
AN - SCOPUS:84858704479
SN - 0021-9150
VL - 221
SP - 527
EP - 535
JO - Atherosclerosis
JF - Atherosclerosis
IS - 2
ER -