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Effects on Mortality and Cardiovascular Events of Adherence to Guideline-Recommended Therapy 4 Years after Lower Extremity Arterial Revascularization
- Source :
- Annals of Vascular Surgery, Annals of Vascular Surgery, Elsevier Masson, 2018, 52, pp.138-146. ⟨10.1016/j.avsg.2018.03.021⟩
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background All patients with lower extremity peripheral arterial disease (LE-PAD) should benefit from recommended pharmacologic therapies including antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and HMG-CoA-reductase inhibitors (statins). In the present study, this triple therapy was defined as the best medical treatment. This study was designed to determine the current risk of cardiovascular (CV) events and mortality and also to evaluate the effect of pharmacologic treatment on patient's survival, CV events, and additional vascular surgery in vascularized LE-PAD patients. This observational, cohort study analyzed prospectively collected data of 140 consecutive patients after hospitalization for LE-PAD revascularization in the vascular surgery department of our university hospital, between January 1 and June 30, 2013. Methods Data from guideline-recommended classes of medications (ACE, ARB, statins, and antiplatelet agents or anticoagulation) were collected at the time of discharge to hospitalization and at the end of the follow-up. Information about mortality, CV events, and additional vascular surgery was collected during follow-up. Results The mean follow-up of patients was 41 months. Mortality and CV events concerned 24% and 12% of the patients, respectively, and additional vascular surgery was performed in 33% of the patients. There was no difference in mortality and CV event rates according to pharmacologic treatment. Additional vascular surgery rate of LE-PAD patients with best medical treatment tended to be lower than without (incidence rate ratio = 0.5777; 95% confidence interval, 0.3101–1.06; P = 0.08). Best medical treatment was prescribed in 54% of patients at discharge of hospitalization. This proportion (54%) was statistically unchanged at the end of follow-up. Conclusions In this small cohort, we failed to show that best medical treatment decreased mortality or CV event rates, but it tended to be associated with decreased additional vascular surgery rate. Further studies taking into consideration the control of CV risk factors could be interesting to demonstrate better outcome from LE-PAD patients with best medical treatment compared with LE-PAD patients without. There is an urgent need for a more effective implementation of currently recommended medication and a continued search after more effective pharmacologic treatment options in LE-PAD.
- Subjects :
- medicine.medical_specialty
Time Factors
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
Revascularization
Risk Assessment
Peripheral Arterial Disease
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Secondary Prevention
medicine
Humans
030212 general & internal medicine
Practice Patterns, Physicians'
ComputingMilieux_MISCELLANEOUS
Retrospective Studies
business.industry
Anticoagulants
Cardiovascular Agents
General Medicine
Guideline
Protective Factors
Vascular surgery
Confidence interval
Treatment Outcome
Lower Extremity
Practice Guidelines as Topic
Cohort
Arterial revascularization
Drug Therapy, Combination
Surgery
Observational study
Guideline Adherence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiology and Cardiovascular Medicine
business
Angiotensin II Type 1 Receptor Blockers
Vascular Surgical Procedures
Platelet Aggregation Inhibitors
Cohort study
Subjects
Details
- ISSN :
- 08905096 and 16155947
- Volume :
- 52
- Database :
- OpenAIRE
- Journal :
- Annals of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....0bdef153a012d1373b01ffcd76c169a0