TY - JOUR
T1 - The impact of prolonged lower limb ischemia on amputation, mortality, and functional status
T2 - The FRIENDS registry
AU - Duval, Sue
AU - Keo, Hong H.
AU - Oldenburg, Niki C.
AU - Baumgartner, Iris
AU - Jaff, Michael R.
AU - Peacock, James M.
AU - Tretinyak, Alexander S.
AU - Henry, Timothy D
AU - Luepker, Russell V
AU - Hirsch, Alan T.
N1 - Publisher Copyright:
© 2014 Mosby, Inc.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background Peripheral artery disease (PAD) is a major cause of cardiovascular ischemic events and amputation. Knowledge gaps exist in defining and measuring key factors that predict these events. The objective of this study was to assess whether duration of limb ischemia would serve as a major predictor of limb and patient survival. Methods The FReedom from Ischemic Events: New Dimensions for Survival (FRIENDS) registry enrolled consecutive patients with limb-threatening peripheral artery disease at a single tertiary care hospital. Demographic information, key clinical care time segments, functional status and use of revascularization, and pharmacotherapy data were collected at baseline, and vascular ischemic events, cardiovascular mortality, and all-cause mortality were recorded at 30 days and 1 year. Results A total of 200 patients with median (interquartile range) age of 76 years (65-84 years) were enrolled in the registry. Median duration of limb ischemia was 0.75 days for acute limb ischemia (ALI) and 61 days for chronic critical limb ischemia (CLI). Duration of limb ischemia of <12, 12 to 24, and >24 hours in patients with ALI was associated with much higher rates of first amputation (P =.0002) and worse amputation-free survival (P =.037). No such associations were observed in patients with CLI. Conclusions For individuals with ischemic symptoms <14 days, prolonged limb ischemia is associated with higher 30-day and 1-year amputation, systemic ischemic event rates, and worse amputation-free survival. No such associations are evident for individuals with chronic CLI. These data imply that prompt diagnosis and revascularization might improve outcomes for patients with ALI.
AB - Background Peripheral artery disease (PAD) is a major cause of cardiovascular ischemic events and amputation. Knowledge gaps exist in defining and measuring key factors that predict these events. The objective of this study was to assess whether duration of limb ischemia would serve as a major predictor of limb and patient survival. Methods The FReedom from Ischemic Events: New Dimensions for Survival (FRIENDS) registry enrolled consecutive patients with limb-threatening peripheral artery disease at a single tertiary care hospital. Demographic information, key clinical care time segments, functional status and use of revascularization, and pharmacotherapy data were collected at baseline, and vascular ischemic events, cardiovascular mortality, and all-cause mortality were recorded at 30 days and 1 year. Results A total of 200 patients with median (interquartile range) age of 76 years (65-84 years) were enrolled in the registry. Median duration of limb ischemia was 0.75 days for acute limb ischemia (ALI) and 61 days for chronic critical limb ischemia (CLI). Duration of limb ischemia of <12, 12 to 24, and >24 hours in patients with ALI was associated with much higher rates of first amputation (P =.0002) and worse amputation-free survival (P =.037). No such associations were observed in patients with CLI. Conclusions For individuals with ischemic symptoms <14 days, prolonged limb ischemia is associated with higher 30-day and 1-year amputation, systemic ischemic event rates, and worse amputation-free survival. No such associations are evident for individuals with chronic CLI. These data imply that prompt diagnosis and revascularization might improve outcomes for patients with ALI.
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U2 - 10.1016/j.ahj.2014.06.013
DO - 10.1016/j.ahj.2014.06.013
M3 - Article
C2 - 25262269
AN - SCOPUS:84914102873
SN - 0002-8703
VL - 168
SP - 577
EP - 587
JO - American Heart Journal
JF - American Heart Journal
IS - 4
ER -