Predictors of Mortality in Patients with Lower Extremity Peripheral Arterial Disease: 5-Year Follow-up

• Published in: Journal of interventional cardiology Vol. 22; no. 6; pp. 564 - 570
• Main Authors: JAFFERY, ZEHRA, GREENBAUM, ADAM B., SIDDIQUI, MOHAMMAD F., MAHENDRAKER, NEETU, GUPTA, VIKESH, MOKKALA, VIDU, KANAKADANDI, UDAY, ROBBINS, ANDREW, MCCORD, JAMES
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.12.2009
• Subjects: Aged; Ankle Brachial Index; Confidence Intervals; Female; Humans; Kaplan-Meier Estimate; Leg - blood supply; Leg - physiopathology; Male; Middle Aged; Multivariate Analysis; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - surgery; Peripheral Arterial Disease - therapy; Proportional Hazards Models; Retrospective Studies; Risk Factors; Time Factors
• ISSN: 0896-4327; 1540-8183
• DOI: 10.1111/j.1540-8183.2009.00505.x

Background: Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long‐term survival benefits of LE arterial revascularization. Methods: Two hundred and eighty‐three patients with an ankle brachial index (ABI) ≤0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all‐cause mortality were measured at 5 years. Results: Of 283 patients identified, 42 (15%) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26%) patients underwent repeat procedures over the 5 years of follow‐up. Those undergoing revascularization were more often Caucasian (95% vs. 79%, P = 0.01) and had lower ABIs (ABI ≤ 0.4, 45% vs. 17%, P = <0.001). At 44 ± 19 months follow‐up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24%) versus 107/241 (44%) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all‐cause mortality (HR 0.51 [95% CI 0.26–1.02], P = 0.056). Independent predictors of mortality were age ≥65 years (HR 2.42 [95% CI 1.52–3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95% CI 1.13–2.46], P = 0.010), chronic kidney disease (HR 1.75 [95% CI 1.15–2.67], P = 0.010), and an ABI ≤ 0.4 (HR 1.88 [95% CI 1.19–2.96], P = 0.006). Conclusion: Few patients at this center with LE‐PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5‐year mortality in those undergoing LE arterial revascularization when compared to those who do not.