PMID- 32276021
OWN - NLM
STAT- MEDLINE
DCOM- 20210315
LR  - 20221207
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 72
IP  - 6
DP  - 2020 Dec
TI  - Improved survival with angiotensin-converting enzyme inhibitors and angiotensin 
      receptor blockers in chronic limb-threatening ischemia.
PG  - 2130-2138
LID - S0741-5214(20)30468-7 [pii]
LID - 10.1016/j.jvs.2020.02.041 [doi]
AB  - OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 
      receptor blockers (ARBs) reduce the risk of cardiovascular events in patients 
      with peripheral artery disease. However, their effect on limb-specific outcomes 
      is unclear. The objective of this study was to assess the effect of ACE 
      inhibitors/ARBs on limb salvage (LS) and survival in patients undergoing 
      peripheral vascular intervention (PVI) for chronic limb-threatening ischemia 
      (CLTI). METHODS: The Vascular Quality Initiative registry was used to identify 
      patients undergoing PVI for CLTI between April 1, 2010, and June 1, 2017. 
      Patients with complete comorbidity, procedural, and follow-up limb and survival 
      data were included. Propensity score matching was performed to control for 
      baseline differences between the groups. LS, amputation-free survival (AFS), and 
      overall survival (OS) were calculated in matched samples using Kaplan-Meier 
      analysis. RESULTS: A total of 12,433 limbs (11,331 patients) were included. The 
      ACE inhibitors/ARBs group of patients had significantly higher prevalence of 
      coronary artery disease (31% vs 27%; P < .001), diabetes (67% vs 57%; P < .001), 
      and hypertension (94% vs 84%; P < .001) and lower incidence of end-stage renal 
      disease (7% vs 12%; P < .001). Indication for intervention was tissue loss in 64% 
      of the ACE inhibitors/ARBs group vs 66% in the no ACE inhibitors/ARBs group (P = 
      .005). Postmatching survival analysis at 5 years showed improved OS (81.8% vs 
      79.9%; P = .01) and AFS (73% vs 71.5%; P = .04) with ACE inhibitors/ARBs but no 
      difference in LS (ACE inhibitors/ARBs, 88.3%; no ACE inhibitors/ARBs, 88.1%; P = 
      .56). After adjustment for multiple variables in a Cox regression model, ACE 
      inhibitors/ARBs were associated with improved OS (hazard ratio, 0.89; 95% 
      confidence interval, 0.80-0.99; P = .03) and AFS (hazard ratio, 0.92; 95% 
      confidence interval, 0.84-0.99; P = .04). CONCLUSIONS: ACE inhibitors/ARBs are 
      independently associated with improved survival and AFS in patients undergoing 
      PVI for CLTI. LS rates remained unaffected. Further research is required to 
      investigate the use of ACE inhibitors/ARBs in this population of patients, 
      especially CLTI patients with other indications for therapy with ACE 
      inhibitors/ARBs.
CI  - Copyright (c) 2020 Society for Vascular Surgery. All rights reserved.
FAU - Khan, Sikandar Z
AU  - Khan SZ
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY. Electronic address: sikandar@buffalo.edu.
FAU - O'Brien-Irr, Monica S
AU  - O'Brien-Irr MS
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Rivero, Mariel
AU  - Rivero M
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY; Department of Surgery, VA Western NY Healthcare System, Buffalo, NY.
FAU - Blochle, Raphael
AU  - Blochle R
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Cherr, Gregory S
AU  - Cherr GS
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Dryjski, Maciej L
AU  - Dryjski ML
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Dosluoglu, Hasan H
AU  - Dosluoglu HH
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Lukan, James
AU  - Lukan J
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Rowe, Vincent L
AU  - Rowe VL
AD  - USC Cardiac and Vascular Institute, Keck School of Medicine of USC, Los Angeles, 
      Calif.
FAU - Harris, Linda M
AU  - Harris LM
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
LA  - eng
PT  - Journal Article
DEP - 20200408
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Angiotensin Receptor Antagonists/*therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Comorbidity
MH  - *Endovascular Procedures/adverse effects/mortality
MH  - Female
MH  - Humans
MH  - Ischemia/diagnosis/mortality/*therapy
MH  - Limb Salvage
MH  - Male
MH  - Peripheral Arterial Disease/diagnosis/mortality/*therapy
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
OTO - NOTNLM
OT  - ACE
OT  - CLTI
OT  - Survival
EDAT- 2020/04/11 06:00
MHDA- 2021/03/16 06:00
CRDT- 2020/04/11 06:00
PHST- 2019/09/03 00:00 [received]
PHST- 2020/02/11 00:00 [accepted]
PHST- 2020/04/11 06:00 [pubmed]
PHST- 2021/03/16 06:00 [medline]
PHST- 2020/04/11 06:00 [entrez]
AID - S0741-5214(20)30468-7 [pii]
AID - 10.1016/j.jvs.2020.02.041 [doi]
PST - ppublish
SO  - J Vasc Surg. 2020 Dec;72(6):2130-2138. doi: 10.1016/j.jvs.2020.02.041. Epub 2020 
      Apr 8.