Impact of Guideline-Directed Medical Therapy on 10-Year Mortality after Revascularization for Patients with Chronic Limb-Threatening Ischemia

• Published in: Journal of Atherosclerosis and Thrombosis Vol. 30; no. 6; pp. 663 - 674
• Main Authors: Hata, Yosuke, Iida, Osamu, Okamoto, Shin, Ishihara, Takayuki, Nanto, Kiyonori, Tsujimura, Takuya, Higashino, Naoko, Toyoshima, Taku, Kitano, Ikurou, Tsuji, Yoshihiko, Takahara, Mitsuyoshi, Mano, Toshiaki
• Format: Journal Article
• Language: English
• Published: Japan Japan Atherosclerosis Society 01.06.2023
• Subjects: Aged; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Bypass surgery; Chronic Limb-Threatening Ischemia; Endovascular Procedures - adverse effects; Endovascular therapy; Guideline-directed medical therapy; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Ischemia - drug therapy; Ischemia - etiology; Limb Salvage; Long-term mortality; Original; Peripheral Arterial Disease - drug therapy; Retrospective Studies; Risk Factors; Stroke Volume; Treatment Outcome; Ventricular Function, Left; Bypass surgery; Endovascular therapy; Long-term mortality; Guideline-directed medical therapy; Chronic limb-threatening ischemia
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.63773

Aims: This study aimed to investigate the long-term impact of guideline-directed medical therapy (GDMT) on 10-year mortality in patients with chronic limb-threatening ischaemia (CLTI) after revascularization.Methods: We performed a retrospective multicentre study enrolle 459 patients with CLTI who underwent revascularization (396 endovascular therapy [EVT] and 63 bypass surgery [BSX] cases) between January 2007 and December 2011. The primary outcome measure was all-cause mortality. We additionally explored the predictors for all-cause mortality using Cox regression hazard models; the influence of GDMT, defined as prescription of antiplatelet agents, statins, and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in aggregate, on all-cause mortality, and the association between baseline characteristics using interaction effects.Results: During the 10-year follow-up after revascularization, 234 patients died. In Kaplan-Meier analysis, 10-year mortality was significantly lower in patients who received statins (p＜.001) and ACE inhibitors or ARBs (p=.010) than those who did not. However, there were no differences in 10-year mortality between patients who received anti-platelet agents and those who did not (p=.62). Interaction analysis revealed that GDMT had a significantly different hazard ratio in patients who were and were not on hemodialysis and in those treated with EVT or BSX (p for interaction =.002 and .044, respectively). In the multivariate analysis, age ＞75 years, non-ambulatory status, hemodialysis, congestive heart failure, left ventricular ejection fraction ＜50%, and GDMT were significantly associated with all-cause mortality.Conclusions: Appropriate GDMT use was independently associated with 10-year mortality in patients with CLTI after revascularization.