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Improved survival with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic limb-threatening ischemia
- Source :
- Journal of vascular surgery. 72(6)
- Publication Year :
- 2019
-
Abstract
- 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).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.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).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.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Population
Ischemia
Angiotensin-Converting Enzyme Inhibitors
Disease
Comorbidity
Risk Assessment
Amputation, Surgical
Coronary artery disease
Angiotensin Receptor Antagonists
Peripheral Arterial Disease
Risk Factors
Internal medicine
medicine
Humans
Registries
education
Aged
Retrospective Studies
Aged, 80 and over
education.field_of_study
biology
business.industry
Endovascular Procedures
Angiotensin-converting enzyme
medicine.disease
Limb Salvage
United States
Treatment Outcome
Propensity score matching
Cardiology
biology.protein
Surgery
Female
Angiotensin Receptor Blockers
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 10976809
- Volume :
- 72
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....8701270507f04fc719412af38b9be343