Abstract 11406: Do the Right Thing: Dramatic Impact of Risk Factor Control in Patients with Claudication Presenting for Peripheral Vascular Interventions
Introduction: Peripheral arterial disease (PAD) is a manifestation of atherosclerosis occurring throughout the cardiovascular system and is predictive of future vascular events. Medical therapy is recommended to improve the long term outcome of patients with PAD.
Hypothesis: We predicted that patients with PAD who underwent peripheral vascular intervention (PVI) would have a high incidence of cardiovascular events within 6 months, and that appropriate medical therapy would be associated with fewer events.
Methods: Using the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention database we identified 686 patients with 6 month follow-up data who received PVI for the purpose of treating lower extremity claudication between 2007 and 2008. Patients with rest symptoms, limb threatening ischemia, or contraindication to aspirin or statin were excluded. Quality of life was measured by the Summary Peripheral Artery Questionnaire Score (S-PAQ) at baseline and 6-months. Minimal medical management prior to PVI was defined as use of aspirin (ASA), statin and smoking abstinence. We measured the combined outcome of death, myocardial infarction, stroke, transient ischemic attack, repeat PVI, amputation, or limb ischemia requiring surgery.
Results: Baseline use of ASA was 82%, statin 72% and smoking abstinence 69%; compliance with all three elements was 44%. Whereas patients treated with all three elements of therapy had better S-PAQ at baseline (45 vs. 40 p=0.01), both groups had similar S-PAQ score at follow-up (75 vs. 74, p=0.49). Outcome events occurred in 12% of the patients during follow-up. In a multivariate mixed-effects logistic regression analysis, treatment with either ASA or statin prior to PVI reduced the odds of an event (OR 0.60; p<0.0001, 95% CI 0.54–-0.66), and treatment with both ASA and statin prior to PVI reduced the odds further (OR 0.36; p<0.0001, 95% CI 0.29–0.44).
Conclusions: The fundamental elements of medical therapy in patients with PAD are often neglected prior to PVI. Post PVI symptoms improved to a similar degree in patients regardless of baseline medical therapy. Failure to be on appropriate medical therapy prior to PVI is associated with an increased risk of cardiovascular events at 6 months.
- © 2010 by American Heart Association, Inc.