Abstract 13080: The Impact of Acei or Arb after Endovascular Treatment or Surgical Reconstruction for Infrainguinal Disease in Patients with Critical Limb Ischemia
Purpose: The aim of this study is to investigate the impact of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) after endovascular treatment(EVT) or surgical reconstruction for infrainguinal disease in patients on outcomes in patients with critical limb ischemia(CLI).
Methods: From January 2004 to December 2009, a retrospective analysis was conducted of data from a multicenter study. 460 patients(33.7% women,232 treated with ACEI or ARB,71.7 ± 10.3 years old) with CLI underwent EVT(223 patients) or surgical reconstruction(237 patients) for de novo infrainguinal lesions. The primary outcome measures was amputation-free survival(AFS). The secondary outcomes were overall survival, major adverse cardiovascular events (MACE; all-cause death, myocardial infarction and stroke) and limb salvage, major adverse limb events (MALE), major adverse cardiovascular and limb events(MACLE) and surgical conversions . Mean follow-up was 28 ± 21 months.
Results: Overall survival, MACE rate at 5 years were significantly higher in the ACEI or ARB-treated group(57.7% vs 44.4% P=0.0267 ; 53.1% vs 36.3% P=0.0131 ; respectively).However AFS, the limb salvage rate, MALE, MACLE, surgical conversion did not differ significantly between them. After correcting all end points with baseline variables, ACEI or ARB was effective for improvement overall survival (hazard ratio [HR], 0.60; 95% confidential interval [CI]. 0.43-0.82; adjusted P=0.0015) and MACE (HR, 0.60; 95% CI. 0.44-0.81; adjusted P=0.0008). The others were no significant difference.
Conclusions: ACEI or ARB may improve overall survival and MACE after EVT or surgical reconstruction for infrainguinal disease in patients with CLI. Overall survival was significantly higher in the ACEI or ARB group, but limb salvage was similar. Therefore, the results of this study showed that for spatient treated with ACEI or ARB , the improved overall survival rate may contribute greatly to the improved AFS.
- © 2013 by American Heart Association, Inc.