Putting the Vascular Back Into Cardiovascular Research
ST-Segment–Elevation Myocardial Infarction as a Blueprint for Improving Care in Patients With Acute Limb Ischemia
Acute limb ischemia is a vascular emergency of the lower extremities characterized by an abrupt loss of limb perfusion that threatens tissue viability and usually presents within 14 days of symptom onset.1,2 More than 200 000 patients in the United States were affected by acute limb ischemia in 2000; >1 in 8 underwent in-hospital amputation; and in-hospital mortality approached 10%.3,4
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Despite the clinical burden of acute limb ischemia, its epidemiological characterization is limited. This deficit is especially striking compared with our understanding of the epidemiology of ST-segment–elevation myocardial infarction (STEMI), a vascular emergency of the coronary arteries. Although important differences in the pathogenesis and epidemiology of these diseases exist, the overlap is notable. STEMI and acute limb ischemia of atherothrombotic origin share vascular risk factors, and acute MI is a risk factor for embolic acute limb ischemia. Additionally, both STEMI and acute limb ischemia require time-critical treatment, and both account for significant cardiovascular morbidity and mortality. Approximately 500 000 STEMIs occurred in the United States in 20015 compared with acute limb ischemia in 213 000 patients.4 Inpatient costs associated with STEMI and acute limb ischemia also are similar, ranging from $14 304 to $23 6786 per hospitalization for STEMI and $6000 to $45 0007,8 per hospitalization for acute limb ischemia. Despite these similarities, our understanding of the epidemiology of acute limb ischemia and the impact of evolving systems of care and new interventional techniques on outcomes lags far behind those of STEMI.
Why the …