PMID- 37150486
OWN - NLM
STAT- MEDLINE
DCOM- 20230724
LR  - 20230724
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 78
IP  - 2
DP  - 2023 Aug
TI  - Optimal medical management in patients undergoing peripheral vascular 
      interventions for chronic limb-threatening ischemia is associated with improved 
      outcomes.
PG  - 490-497
LID - S0741-5214(23)01068-6 [pii]
LID - 10.1016/j.jvs.2023.04.025 [doi]
AB  - OBJECTIVE: Optimizing medical management and risk factor modification are 
      underused strategies in patients with chronic limb-threatening ischemia (CLTI), 
      despite evidence of improved outcomes. The Vascular Quality Initiative (VQI) 
      registry is a tool to improve quality of vascular care. In this study, we used 
      the VQI to evaluate trends in medical management in patients with CLTI undergoing 
      peripheral vascular interventions (PVI), and the impact of changes in management 
      on overall survival (OS), amputation-free survival (AFS), and limb salvage (LS). 
      METHODS: Patients undergoing index PVI for CLTI between 2012 and 2016, with >/=24 
      months of follow-up were identified from the national VQI registry. Patient 
      details including smoking status and medication use, OS, LS, and AFS were 
      analyzed with linear-by-linear association, t test, and logistic regression. 
      RESULTS: There were 12,370 PVI completed in 11,466 patients. There was a 
      significant increase in infrapopliteal interventions (from 29.8% to 39.0%; P < 
      .001) and PVI performed for tissue loss (from 59.1% to 66.5%; P < .001). The 
      percentage of current smokers at time of PVI decreased (from 36.2% to 30.7%; P = 
      .036). At discharge, statins were initiated in 25%, aspirin in 45%, and P2Y12 
      therapy in 58% of patients not receiving these medications before PVI. Over the 
      course of follow-up, dual antiplatelet therapy (DAPT) (from 41.1% to 48.0%; P < 
      .001), angiotensin-converting enzyme (ACE) inhibitor (from 46.2% to 51.3%; P < 
      .001), and statin (from 70.4% to 77.5%; P < .001) use increased. Combined DAPT, 
      ACE inhibitor and statin use increased from 33.6% to 39.6% (P </= .001). 
      Significant improvement in 24-month OS and AFS was noted (OS, from 90.9% to 93.7% 
      [P = .002]: AFS, from 81.2% to 83.1% [P = .046]), but not LS (from 89.6% to 
      89.0%; P = .83). Combined therapy with P2Y12 inhibitors, statins and ACE 
      inhibitors was an independent predictor of improved OS (hazard ratio, 0.61; 95% 
      confidence interval, 0.39-0.96; P = .034). DAPT was independent predictor of 
      improved LS (hazard ratio, 0.83; 95% confidence interval, 0.79-0.87; P < .007). 
      CONCLUSIONS: Antiplatelet, ACE inhibitor, and statin use increased over the study 
      period and was associated with improved OS and AFS. LS trends did not change 
      significantly over time, possibly owing to the inclusion of patients with a 
      greater disease burden or inadequate medical management. Medical management, 
      although improved, remained far from optimal and represents an area for continued 
      development.
CI  - Copyright (c) 2023 Society for Vascular Surgery. All rights reserved.
FAU - Chang, Matthew
AU  - Chang M
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - O'Brien-Irr, Monica S
AU  - O'Brien-Irr MS
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - Shaw, JoAnna F
AU  - Shaw JF
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - Montross, Brittany C
AU  - Montross BC
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - Dosluoglu, Hasan H
AU  - Dosluoglu HH
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - Harris, Linda M
AU  - Harris LM
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - Dryjski, Maciej L
AU  - Dryjski ML
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY.
FAU - Khan, Sikandar Z
AU  - Khan SZ
AD  - Department of Vascular Surgery, University at Buffalo, Buffalo, NY. Electronic 
      address: sikandarzkhan@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20230506
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
MH  - Humans
MH  - Chronic Limb-Threatening Ischemia
MH  - *Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Risk Assessment
MH  - *Endovascular Procedures/adverse effects
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - *Peripheral Arterial Disease/diagnosis/therapy
MH  - Ischemia/diagnosis/therapy
MH  - Risk Factors
MH  - Limb Salvage
MH  - Angiotensin-Converting Enzyme Inhibitors
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - CLTI
OT  - Optimal medical management
OT  - Peripheral vascular interventions
OT  - Prescribing patterns in PAD
EDAT- 2023/05/08 00:41
MHDA- 2023/07/24 06:42
CRDT- 2023/05/07 19:29
PHST- 2023/01/16 00:00 [received]
PHST- 2023/04/13 00:00 [revised]
PHST- 2023/04/14 00:00 [accepted]
PHST- 2023/07/24 06:42 [medline]
PHST- 2023/05/08 00:41 [pubmed]
PHST- 2023/05/07 19:29 [entrez]
AID - S0741-5214(23)01068-6 [pii]
AID - 10.1016/j.jvs.2023.04.025 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Aug;78(2):490-497. doi: 10.1016/j.jvs.2023.04.025. Epub 2023 
      May 6.