Putting the "Vascular" Back into Cardiovascular Research: ST-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 U.S. were affected by acute limb ischemia in 2000, more than 1 in 8 underwent in-hospital amputation, and in-hospital mortality approached 10%.3, 4
Despite the clinical burden of acute limb ischemia, its epidemiologic characterization is limited. This deficit is especially striking in comparison to our understanding of the epidemiology of ST-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 U.S. in 20015 compared to 213,000 patients with acute limb ischemia4. Inpatient costs associated with STEMI and acute limb ischemia are similar as well, ranging from $14,304 - $23,6786 for STEMI, and $6000 - $450007, 8 for acute limb ischemia. Despite the 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 STEMI.
- Received June 3, 2013.
- Accepted June 4, 2013.