Long-term survival and fate of the leg in de novo intermittent claudication

Long-term survival and fate of the leg in de novo intermittent claudication

Abstract Aims The long-term life expectancy and fate of the leg, including progression rate to critical limb ischaemia (CLI), were analysed in de novo patients with intermittent claudication (IC). Methods and results A prospective cohort study was performed in 1107 patients with de novo IC. The endp...

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Veröffentlicht in:European heart journal. Quality of care & clinical outcomes 2017-07, Vol.3 (3), p.208-215
Hauptverfasser: Kumakura, Hisao, Kanai, Hiroyoshi, Hojo, Yoshiaki, Iwasaki, Toshiya, Ichikawa, Shuichi
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Cardiovascular disease
Diabetes
Health risk assessment
Hemodialysis
Life expectancy
Mortality
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container_title European heart journal. Quality of care & clinical outcomes
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creator Kumakura, Hisao
Kanai, Hiroyoshi
Hojo, Yoshiaki
Iwasaki, Toshiya
Ichikawa, Shuichi
description Abstract Aims The long-term life expectancy and fate of the leg, including progression rate to critical limb ischaemia (CLI), were analysed in de novo patients with intermittent claudication (IC). Methods and results A prospective cohort study was performed in 1107 patients with de novo IC. The endpoints were overall survival (OS), freedom from major adverse cardiovascular events (MACE), freedom from major adverse cardiovascular and limb events (MACLE), and fate of the leg. The 5-, 10-, 15-, and 20-year rates were 73.3, 47.8, 28.1, and 14.9% for OS, and 63.0, 35.6, 18.5, and 5.7% for freedom from MACE, respectively. In Cox multivariable analysis, body mass index, diabetes, haemodialysis, and C-reactive protein (CRP) level were correlated with OS (P 
doi_str_mv 10.1093/ehjqcco/qcw057
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Methods and results A prospective cohort study was performed in 1107 patients with de novo IC. The endpoints were overall survival (OS), freedom from major adverse cardiovascular events (MACE), freedom from major adverse cardiovascular and limb events (MACLE), and fate of the leg. The 5-, 10-, 15-, and 20-year rates were 73.3, 47.8, 28.1, and 14.9% for OS, and 63.0, 35.6, 18.5, and 5.7% for freedom from MACE, respectively. In Cox multivariable analysis, body mass index, diabetes, haemodialysis, and C-reactive protein (CRP) level were correlated with OS (P &lt; 0.05). Ankle brachial pressure index, diabetes, coronary artery disease, haemodialysis, and CRP level were independently correlated with freedom from MACE and MACLE. Statins improved mortality, MACE, and MACLE (P &lt; 0.05). Revascularization did not improve mortality and MACE, and femoropopliteal revascularization increased MACLE (P &lt; 0.05). There was no deterioration of claudication in 881 patients (79.6%). Worsening claudication was noted in 211 patients (14.8% per 5 years), and 15 patients (1.1% per 5 years) worsened to CLI. Diabetes and haemodialysis were independent predictors of CLI. A history of cerebral infarction and femoropopliteal revascularization tended to increase CLI. Conclusions Life expectancy in patients with IC was poor, but the rate of IC progression to CLI was low. Statins improved mortality and morbidity, revascularization did not improve mortality and MACE, and femoropopliteal revascularization reduced freedom from MACLE with a risk of CLI.</description><identifier>ISSN: 2058-5225</identifier><identifier>EISSN: 2058-1742</identifier><identifier>DOI: 10.1093/ehjqcco/qcw057</identifier><identifier>PMID: 28838085</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Cardiovascular disease ; Diabetes ; Health risk assessment ; Hemodialysis ; Life expectancy ; Mortality</subject><ispartof>European heart journal. Quality of care &amp; clinical outcomes, 2017-07, Vol.3 (3), p.208-215</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com. 2017</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.</rights><rights>Copyright © 2017 European Society of Cardiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-33e8f1bfcb8bb5804d70bce9f31eadeee81fe2602e670aee5d3116d0641078d3</citedby><cites>FETCH-LOGICAL-c463t-33e8f1bfcb8bb5804d70bce9f31eadeee81fe2602e670aee5d3116d0641078d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28838085$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumakura, Hisao</creatorcontrib><creatorcontrib>Kanai, Hiroyoshi</creatorcontrib><creatorcontrib>Hojo, Yoshiaki</creatorcontrib><creatorcontrib>Iwasaki, Toshiya</creatorcontrib><creatorcontrib>Ichikawa, Shuichi</creatorcontrib><title>Long-term survival and fate of the leg in de novo intermittent claudication</title><title>European heart journal. Quality of care &amp; clinical outcomes</title><addtitle>Eur Heart J Qual Care Clin Outcomes</addtitle><description>Abstract Aims The long-term life expectancy and fate of the leg, including progression rate to critical limb ischaemia (CLI), were analysed in de novo patients with intermittent claudication (IC). Methods and results A prospective cohort study was performed in 1107 patients with de novo IC. The endpoints were overall survival (OS), freedom from major adverse cardiovascular events (MACE), freedom from major adverse cardiovascular and limb events (MACLE), and fate of the leg. The 5-, 10-, 15-, and 20-year rates were 73.3, 47.8, 28.1, and 14.9% for OS, and 63.0, 35.6, 18.5, and 5.7% for freedom from MACE, respectively. In Cox multivariable analysis, body mass index, diabetes, haemodialysis, and C-reactive protein (CRP) level were correlated with OS (P &lt; 0.05). Ankle brachial pressure index, diabetes, coronary artery disease, haemodialysis, and CRP level were independently correlated with freedom from MACE and MACLE. Statins improved mortality, MACE, and MACLE (P &lt; 0.05). Revascularization did not improve mortality and MACE, and femoropopliteal revascularization increased MACLE (P &lt; 0.05). There was no deterioration of claudication in 881 patients (79.6%). Worsening claudication was noted in 211 patients (14.8% per 5 years), and 15 patients (1.1% per 5 years) worsened to CLI. Diabetes and haemodialysis were independent predictors of CLI. A history of cerebral infarction and femoropopliteal revascularization tended to increase CLI. Conclusions Life expectancy in patients with IC was poor, but the rate of IC progression to CLI was low. Statins improved mortality and morbidity, revascularization did not improve mortality and MACE, and femoropopliteal revascularization reduced freedom from MACLE with a risk of CLI.</description><subject>Cardiovascular disease</subject><subject>Diabetes</subject><subject>Health risk assessment</subject><subject>Hemodialysis</subject><subject>Life expectancy</subject><subject>Mortality</subject><issn>2058-5225</issn><issn>2058-1742</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNqF0M1LwzAYBvAgihu6q0cJeNFDt3z0Iz3K8AsHXnYvafJm62ibrUkn_vdmtHrwIgTyHn7vw8uD0A0lc0pyvoDt7qCUXRzUJ0myMzRlJBERzWJ2Ps4JY8kEzZzbEUJoyjNK00s0YUJwQUQyRe8r224iD12DXd8dq6OssWw1NtIDtgb7LeAaNrhqsQbc2qMN44lX3kPrsaplryslfWXba3RhZO1gNv5XaP38tF6-RquPl7fl4ypSccp9xDkIQ0ujSlGWiSCxzkipIDecgtQAIKgBlhIGaUYkQKJ5uFqTNKYkE5pfofshdt_ZQw_OF03lFNS1bMH2rqA5Z4LnCReB3v2hO9t3bTguqDQPj9MsqPmgVGed68AU-65qZPdVUFKcii7Goouh6LBwO8b2ZQP6l__UGsDDAGy__y_sGywriYo</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Kumakura, Hisao</creator><creator>Kanai, Hiroyoshi</creator><creator>Hojo, Yoshiaki</creator><creator>Iwasaki, Toshiya</creator><creator>Ichikawa, Shuichi</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Long-term survival and fate of the leg in de novo intermittent claudication</title><author>Kumakura, Hisao ; Kanai, Hiroyoshi ; Hojo, Yoshiaki ; Iwasaki, Toshiya ; Ichikawa, Shuichi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-33e8f1bfcb8bb5804d70bce9f31eadeee81fe2602e670aee5d3116d0641078d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Cardiovascular disease</topic><topic>Diabetes</topic><topic>Health risk assessment</topic><topic>Hemodialysis</topic><topic>Life expectancy</topic><topic>Mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumakura, Hisao</creatorcontrib><creatorcontrib>Kanai, Hiroyoshi</creatorcontrib><creatorcontrib>Hojo, Yoshiaki</creatorcontrib><creatorcontrib>Iwasaki, Toshiya</creatorcontrib><creatorcontrib>Ichikawa, Shuichi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Quality of care &amp; clinical outcomes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumakura, Hisao</au><au>Kanai, Hiroyoshi</au><au>Hojo, Yoshiaki</au><au>Iwasaki, Toshiya</au><au>Ichikawa, Shuichi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term survival and fate of the leg in de novo intermittent claudication</atitle><jtitle>European heart journal. Quality of care &amp; clinical outcomes</jtitle><addtitle>Eur Heart J Qual Care Clin Outcomes</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>3</volume><issue>3</issue><spage>208</spage><epage>215</epage><pages>208-215</pages><issn>2058-5225</issn><eissn>2058-1742</eissn><abstract>Abstract Aims The long-term life expectancy and fate of the leg, including progression rate to critical limb ischaemia (CLI), were analysed in de novo patients with intermittent claudication (IC). Methods and results A prospective cohort study was performed in 1107 patients with de novo IC. The endpoints were overall survival (OS), freedom from major adverse cardiovascular events (MACE), freedom from major adverse cardiovascular and limb events (MACLE), and fate of the leg. The 5-, 10-, 15-, and 20-year rates were 73.3, 47.8, 28.1, and 14.9% for OS, and 63.0, 35.6, 18.5, and 5.7% for freedom from MACE, respectively. In Cox multivariable analysis, body mass index, diabetes, haemodialysis, and C-reactive protein (CRP) level were correlated with OS (P &lt; 0.05). Ankle brachial pressure index, diabetes, coronary artery disease, haemodialysis, and CRP level were independently correlated with freedom from MACE and MACLE. Statins improved mortality, MACE, and MACLE (P &lt; 0.05). Revascularization did not improve mortality and MACE, and femoropopliteal revascularization increased MACLE (P &lt; 0.05). There was no deterioration of claudication in 881 patients (79.6%). Worsening claudication was noted in 211 patients (14.8% per 5 years), and 15 patients (1.1% per 5 years) worsened to CLI. Diabetes and haemodialysis were independent predictors of CLI. A history of cerebral infarction and femoropopliteal revascularization tended to increase CLI. Conclusions Life expectancy in patients with IC was poor, but the rate of IC progression to CLI was low. Statins improved mortality and morbidity, revascularization did not improve mortality and MACE, and femoropopliteal revascularization reduced freedom from MACLE with a risk of CLI.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>28838085</pmid><doi>10.1093/ehjqcco/qcw057</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Cardiovascular disease
Diabetes
Health risk assessment
Hemodialysis
Life expectancy
Mortality
title Long-term survival and fate of the leg in de novo intermittent claudication
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