PMID- 35709863
OWN - NLM
STAT- MEDLINE
DCOM- 20220928
LR  - 20221025
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 76
IP  - 4
DP  - 2022 Oct
TI  - P2Y12 inhibitor monotherapy is associated with superior outcomes as compared with 
      aspirin monotherapy in chronic limb-threatening ischemia.
PG  - 1053-1059
LID - S0741-5214(22)01628-7 [pii]
LID - 10.1016/j.jvs.2022.04.047 [doi]
AB  - OBJECTIVE: Antiplatelet therapy is recommended in patients with peripheral 
      arterial disease to reduce cardiovascular risk and improve outcomes. However, 
      issues including the drug of choice and use of dual antiplatelet therapy (DAPT) 
      vs monotherapy remain unclear. This study aims to compare the impact of aspirin 
      (ASA) monotherapy, P2Y12 monotherapy, and DAPT on limb salvage (LS), 
      amputation-free survival (AFS), and overall survival (OS) in patients undergoing 
      lower extremity peripheral endovascular intervention (PVI) for chronic 
      limb-threatening ischemia (CLTI). METHODS: The Vascular Quality Initiative PVI 
      registry was used to identify index procedures completed for CLTI between March 
      1, 2010 and September 30, 2017. Patients were categorized by antiplatelet use at 
      the time of last follow-up. Patients not on antiplatelet therapy were compared 
      with ASA, P2Y12 monotherapy, and DAPT. Propensity score-matched samples were 
      created for direct ASA vs P2Y12 and P2Y12 vs DAPT comparisons; veracity was 
      confirmed by chi(2) and Hosmer-Lemeshow tests. Kaplan-Meier and Cox regression were 
      performed for OS, AFS, and LS. RESULTS: A total of 12,433 index PVI were 
      completed for CLTI in 11,503 subjects in the pre-matched sample. Antiplatelet use 
      at follow-up was: 12% none, 31% ASA, 14% P2Y12, and 43% DAPT. Median follow-up 
      was 1389 days. P2Y12 monotherapy was associated with improved outcomes as 
      compared with ASA monotherapy, OS (87.8% vs 85.5%l P = .026; Cox hazard ratio 
      [HR], 0.82; 95% confidence interval [CI], 0.68-0.98; P = .03), AFS (79.6% vs 
      74.8%; P < .001; Cox HR, 0.75; 95% CI, 0.65-0.86; P < .001) and LS (89.5% vs 
      86.8%; P = .013; Cox HR, 0.74; 95% CI, 0.60-0.91; P = .004). P2Y12 monotherapy 
      and DAPT had comparable OS (87.8% vs 88.9%; P = .62; Cox HR, 0.94; 95% CI, 
      0.77-1.14; P = .50), AFS (79.6% vs 81.5%; P = .33; Cox HR, 0.92; 95% CI, 
      0.78-1.07; P = .28), and LS (91.7% vs 89.4; P = .03; Cox HR, 0.80; 95% CI, 
      0.64-1.00; P = .06). CONCLUSIONS: P2Y12 monotherapy was associated with superior 
      OS, AFS, and LS as compared with ASA monotherapy, and comparable OS, LS, and AFS 
      with DAPT in patients undergoing PVI for CLTI. P2Y12 monotherapy may be 
      considered over ASA monotherapy and DAPT in patients with CLTI, especially in 
      patients with high bleeding risk.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
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 - Fakhoury, Elias
AU  - Fakhoury E
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY.
FAU - Montross, Brittany
AU  - Montross B
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; VA Western NY Healthcare System, Buffalo, NY.
FAU - Dosluoglu, Hasan H
AU  - Dosluoglu HH
AD  - Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, 
      NY; VA Western NY Healthcare System, Buffalo, NY.
FAU - Harris, Linda M
AU  - Harris LM
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.
LA  - eng
PT  - Journal Article
DEP - 20220613
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - *Aspirin/adverse effects
MH  - Chronic Limb-Threatening Ischemia
MH  - Humans
MH  - Ischemia/diagnosis/drug therapy
MH  - *Peripheral Arterial Disease/diagnostic imaging/drug therapy
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Antiplatelet
OT  - Medical management
OT  - Peripheral arterial disease
EDAT- 2022/06/17 06:00
MHDA- 2022/09/28 06:00
CRDT- 2022/06/16 19:22
PHST- 2021/12/15 00:00 [received]
PHST- 2022/03/31 00:00 [revised]
PHST- 2022/04/17 00:00 [accepted]
PHST- 2022/06/17 06:00 [pubmed]
PHST- 2022/09/28 06:00 [medline]
PHST- 2022/06/16 19:22 [entrez]
AID - S0741-5214(22)01628-7 [pii]
AID - 10.1016/j.jvs.2022.04.047 [doi]
PST - ppublish
SO  - J Vasc Surg. 2022 Oct;76(4):1053-1059. doi: 10.1016/j.jvs.2022.04.047. Epub 2022 
      Jun 13.