Editor's Choice – Impact of Comorbidity, Medication, and Gender on Amputation Rate Following Revascularisation for Chronic Limb Threatening Ischaemia
Baubeta Fridh, Erik LU
; Andersson, Manne
; Thuresson, Marcus
; Sigvant, Birgitta
; Kragsterman, Björn
; Johansson, Saga
; Hasvold, Pål
; Nordanstig, Joakim
and Falkenberg, Mårten
(2018)
In European journal of vascular and endovascular surgery
56(5).
p.681-688
- Abstract
Objective/background: Chronic limb threatening ischaemia (CLTI) has a high risk of amputation and mortality. Increased knowledge on how sex, comorbidities, and medication influence these outcomes after revascularisation may help optimise results and patient selection. Methods: This population based observational cohort study included all individuals revascularised for CLTI in Sweden during a five year period (10,617 patients in total). Data were retrieved and merged from mandatory national healthcare registries, and specifics on amputations were validated with individual medical records. Results: Mean age at revascularisation was 76.8 years. Median follow up was 2.7 years (range 0–6.6 years). Male sex (hazard ratio [HR] 1.20, 95%... (More)
Objective/background: Chronic limb threatening ischaemia (CLTI) has a high risk of amputation and mortality. Increased knowledge on how sex, comorbidities, and medication influence these outcomes after revascularisation may help optimise results and patient selection. Methods: This population based observational cohort study included all individuals revascularised for CLTI in Sweden during a five year period (10,617 patients in total). Data were retrieved and merged from mandatory national healthcare registries, and specifics on amputations were validated with individual medical records. Results: Mean age at revascularisation was 76.8 years. Median follow up was 2.7 years (range 0–6.6 years). Male sex (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.33), renal insufficiency (HR 1.57, 95% CI 1.32–1.87), diabetes (HR 1.45, 95% CI 1.32–1.60), and heart failure (HR 1.17, 95% CI 1.05–1.31) were independently associated with an increased amputation rate, whereas the use of statins (HR 0.71, 95% CI 0.64–0.78) and low dose acetylsalicylic acid (HR 0.77, 95% CI 0.70–0.86) were associated with a reduced amputation rate. For the combined end point of amputation or death, an association with increased rates was found for male sex (HR 1.25, 95% CI 1.18–1.32), renal insufficiency (HR 1.94, 95% CI 1.75–2.14), heart failure (HR 1.50, 95% CI 1.40–1.60), and diabetes (HR 1.31, 95% CI 1.23–1.38). The use of statins (HR 0.74, 95% CI 0.67–0.82) and low dose acetylsalicylic acid (HR 0.82, 95% CI 0.77–0.88]) were related to a reduced risk of amputation or death. Conclusions: Renal insufficiency is the strongest independent risk factor for both amputation and amputation/death in revascularised CLTI patients, followed by diabetes and heart failure. Men with CLTI have worse outcomes than women. These results may help govern patient selection for revascularisation procedures. Statin and low dose acetylsalicylic acid are associated with an improved limb outcome. This underlines the importance of preventive medication to reduce general cardiovascular risk and increase limb salvage.
(Less)
- author
- Baubeta Fridh, Erik
LU
; Andersson, Manne
; Thuresson, Marcus
; Sigvant, Birgitta
; Kragsterman, Björn
; Johansson, Saga
; Hasvold, Pål
; Nordanstig, Joakim
and Falkenberg, Mårten
- publishing date
- 2018
- type
- Contribution to journal
- publication status
- published
- keywords
- Amputation, Arterial occlusive diseases, Atherosclerosis, Comorbidity, Mortality, Peripheral arterial disease
- in
- European journal of vascular and endovascular surgery
- volume
- 56
- issue
- 5
- pages
- 681 - 688
- publisher
- Elsevier
- external identifiers
-
- scopus:85050967718
- pmid:30093176
- ISSN
- 1078-5884
- DOI
- 10.1016/j.ejvs.2018.06.003
- language
- English
- LU publication?
- no
- additional info
- Publisher Copyright: © 2018 European Society for Vascular Surgery
- id
- 031b1490-128f-4af7-b45b-f5c48ea20bea
- date added to LUP
- 2022-04-04 10:57:15
- date last changed
- 2024-06-17 17:32:43
@article{031b1490-128f-4af7-b45b-f5c48ea20bea,
abstract = {{<p>Objective/background: Chronic limb threatening ischaemia (CLTI) has a high risk of amputation and mortality. Increased knowledge on how sex, comorbidities, and medication influence these outcomes after revascularisation may help optimise results and patient selection. Methods: This population based observational cohort study included all individuals revascularised for CLTI in Sweden during a five year period (10,617 patients in total). Data were retrieved and merged from mandatory national healthcare registries, and specifics on amputations were validated with individual medical records. Results: Mean age at revascularisation was 76.8 years. Median follow up was 2.7 years (range 0–6.6 years). Male sex (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.33), renal insufficiency (HR 1.57, 95% CI 1.32–1.87), diabetes (HR 1.45, 95% CI 1.32–1.60), and heart failure (HR 1.17, 95% CI 1.05–1.31) were independently associated with an increased amputation rate, whereas the use of statins (HR 0.71, 95% CI 0.64–0.78) and low dose acetylsalicylic acid (HR 0.77, 95% CI 0.70–0.86) were associated with a reduced amputation rate. For the combined end point of amputation or death, an association with increased rates was found for male sex (HR 1.25, 95% CI 1.18–1.32), renal insufficiency (HR 1.94, 95% CI 1.75–2.14), heart failure (HR 1.50, 95% CI 1.40–1.60), and diabetes (HR 1.31, 95% CI 1.23–1.38). The use of statins (HR 0.74, 95% CI 0.67–0.82) and low dose acetylsalicylic acid (HR 0.82, 95% CI 0.77–0.88]) were related to a reduced risk of amputation or death. Conclusions: Renal insufficiency is the strongest independent risk factor for both amputation and amputation/death in revascularised CLTI patients, followed by diabetes and heart failure. Men with CLTI have worse outcomes than women. These results may help govern patient selection for revascularisation procedures. Statin and low dose acetylsalicylic acid are associated with an improved limb outcome. This underlines the importance of preventive medication to reduce general cardiovascular risk and increase limb salvage.</p>}},
author = {{Baubeta Fridh, Erik and Andersson, Manne and Thuresson, Marcus and Sigvant, Birgitta and Kragsterman, Björn and Johansson, Saga and Hasvold, Pål and Nordanstig, Joakim and Falkenberg, Mårten}},
issn = {{1078-5884}},
keywords = {{Amputation; Arterial occlusive diseases; Atherosclerosis; Comorbidity; Mortality; Peripheral arterial disease}},
language = {{eng}},
number = {{5}},
pages = {{681--688}},
publisher = {{Elsevier}},
series = {{European journal of vascular and endovascular surgery}},
title = {{Editor's Choice – Impact of Comorbidity, Medication, and Gender on Amputation Rate Following Revascularisation for Chronic Limb Threatening Ischaemia}},
url = {{http://dx.doi.org/10.1016/j.ejvs.2018.06.003}},
doi = {{10.1016/j.ejvs.2018.06.003}},
volume = {{56}},
year = {{2018}},
}