Outcome events in patients with claudication: A 15-year study in 2777 patients

• Published in: Journal of vascular surgery Vol. 33; no. 2; pp. 251 - 258
• Main Authors: Muluk, Satish C., Muluk, Visala S., Kelley, Mary E., Whittle, Jeffrey C., Tierney, Jill A., Webster, Marshall W., Makaroun, Michel S.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2001
• Subjects: Aged; Aged, 80 and over; Amputation; Follow-Up Studies; Humans; Intermittent Claudication - mortality; Intermittent Claudication - therapy; Leg - surgery; Male; Middle Aged; Multivariate Analysis; Outcome Assessment (Health Care); Proportional Hazards Models; Risk Factors; Survival Rate; United States - epidemiology; Vascular Surgical Procedures; United States
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2001.112210

Objective: The purpose of this study was to delineate the natural history of claudication and determine risk factors for death. Methods: We reviewed the key outcomes (death, revascularization, amputation) in 2777 male patients with claudication identified over 15 years at a Veterans Administration hospital with both clinical and noninvasive criteria. Patients with rest pain or ulcers were excluded. Data were analyzed with life-table and Cox hazard models. Results: The mean follow-up was 47 months. The cohort exhibited a mortality rate of 12% per year, which was significantly (P <.05) more than the age-adjusted US male population. Among the deaths in which the cause was known, 66% were due to heart disease. We examined several baseline risk factors in a multivariate Cox model. Four were significant (P <.01) independent predictors of death: older age (relative risk [RR] = 1.3 per decade), lower ankle-brachial index (RR = 1.2 for 0.2 change), diabetes requiring medication (RR = 1.4), and stroke (RR = 1.4). The model can be used to estimate the mortality rate for specific patients. Surprisingly, a history of angina and myocardial infarction was not a significant predictor. Major and minor amputations had a 10-year cumulative rate less than 10%. Revascularization procedures occurred with a 10-year cumulative rate of 18%. Conclusions: We found a high mortality rate in this large cohort and four independent risk factors that have a large impact on survival. Risk stratification with our model may be useful in determining an overall therapeutic plan for claudicants. A history of angina and myocardial infarction was not a useful predictor of death, suggesting that many patients in our cohort presented with claudication before having coronary artery symptoms. Our data also indicate that claudicants have a low risk of major amputation at 10-year follow-up. (J Vasc Surg 2001;33:251-8.)