Abstract 16935: Increased Adherence to Guideline-Recommended Therapy is Associated With Decreased Major Adverse Cardiovascular Events and Major Adverse Limb Events Among Patients With Claudication or Critical Limb Ischemia
Introduction: Treatment guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statins, and angiotensin-converting enzyme inhibitors (ACEI). The additive effects of multiple guideline-recommended therapies in symptomatic PAD patients have not been well characterized.
Hypothesis: We hypothesized that increased adherence to guideline-recommended therapies for patients with claudication or critical limb ischemia (CLI) undergoing angiography is associated with reduced subsequent major adverse cardiovascular and cerebrovascular events (MACCE: myocardial infarction, stroke, death) and major adverse limb events (MALE: major amputation or surgical bypass).
Methods: We analyzed a comprehensive database of all patients with claudication or CLI who underwent diagnostic or interventional lower extremity angiography between 2006 and 2013 at a single vascular center. Baseline demographics, clinical data, and long-term outcomes were obtained. Kaplan-Meier analysis and inverse probability of treatment propensity weighting were used to determine the long-term risk of MACCE, MALE, and all-cause mortality.
Results: Among 739 patients, 325 (44%) had claudication and 414 (56%) had CLI. Guideline-recommended therapies at baseline included aspirin use in 651 (88%), statin use in 496 (67%), ACE inhibitor use in 445 (60%), and smoking cessation in 528 (71%) patients. A total of 237 (32%) patients met all four guideline-recommended therapies. After adjustment for baseline covariates, patients receiving all four guideline therapies had decreased MACCE (HR 0.61, 95% CI 0.41-0.89), MALE (HR 0.55, 95% CI 0.36-0.84), and mortality (HR 0.57, 95% CI 0.37-0.88) compared to patients receiving <4 of the recommended therapies. (Figure)
Conclusions: In patients with claudication or CLI, combination treatment with four guideline-recommended therapies is associated with significant reductions in MACCE and MALE.
- © 2013 by American Heart Association, Inc.