Fate of individuals with ischemic amputations in the REACH Registry: Three-year cardiovascular and limb-related outcomes

Maria Teresa B. Abola, Deepak L. Bhatt, Sue Duval, Patrice P. Cacoub, Iris Baumgartner, Hong Keo, Mark A. Creager, Danielle M. Brennan, Ph Gabriel Steg, Alan T Hirsch

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)527-535
Number of pages9
JournalAtherosclerosis
Volume221
Issue number2
DOIs
StatePublished - Apr 2012

Bibliographical note

Funding Information:
Dr Cacoub has received research grants from sanofi-aventis, Schering Plough, Servier, and Roche; honoraria from sanofi-aventis, Schering Plough, Servier, Roche, AstraZeneca, and Bristol-Myers Squibb.

Funding Information:
Dr. Abola received honoraria from AstraZeneca, Bayer, Boehringer-Ingelheim, GSK, Otsuka, Servier, and sanofi-aventis, and research grants from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, GSK and sanofi-aventis.

Funding Information:
Dr Creager has received a research grant from Sanofi-Aventis and consulting fees from AstraZeneca, Genzyme, Merck, and Vasogen.

Keywords

  • Amputation
  • Atherosclerosis
  • Critical limb ischemia
  • Health outcomes
  • Myocardial infarction
  • Peripheral artery disease

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