Abstract 13887: Lower Extremity Artery Calcification Predicts Amputation and Mortality in Advanced Peripheral Arterial Disease Patients
Objective: The clinical application of coronary artery calcium score has been well-demonstrated. However, little is known about the association of lower extremity artery calcium score with clinical symptoms and outcomes.
Methods: A total of 82 advanced peripheral arterial disease patients (56 men, mean age 61.0 ± 12.4 years, 12 under regular hemodialysis, 47 in Fontaine stage IV) with multidetector computed tomography images were followed for 21 ± 11 months. Calcium scores were analyzed by the same protocol as Agatston score in coronary arteries retrospectively. The studied lower extremity arteries ranged from the bifurcation of aorta and common iliac artery to the ankle area, including all main trunk and main branches. The primary end points of this study were amputation and mortality.
Results: Old age, diabetes, hyperlipidemia and end stage renal disease were associated with higher calcium scores. Patients with more advanced Fontaine stages also tended to have higher calcium scores (P = 0.027). However, high calcium scores were not associated with history of coronary and cerebral vascular disease. The calcium scores were highly correlated between bilateral legs (r = 0.98, P <0.001), and the segmental calcium scores were also highly correlated between different arterial segments (iliac, above-knee, and below-knee segment). Multiple regression analysis demonstrated that age and total cholesterol level were the independent predictors for overall calcium scores. During the follow-up period, 29 (35%) patients received amputation, and 24 (29%) patients expired. Among the amputation patients, there was no significant difference in calcium scores between the amputation legs and the non-amputation legs (P = 0.88). After age and gender adjustment, patients in high calcium score group (calcium score ≥11000, n = 41) had 2.42 (95% CI 1.09 - 5.37, P = 0.029) and 2.81-fold (95% CI 1.08 - 7.39, P = 0.034) higher risks for amputation and overall mortality than patients in low calcium score group, although the significance attenuated after further traditional cardiovascular risks adjustment.
Conclusions: High lower extremity artery calcium scores are associated with higher amputation and mortality rate in advanced peripheral arterial disease patients.
- © 2013 by American Heart Association, Inc.