E. S. van Hattum (1), M. J. D. Tangelder (1), J. A. Lawson (2), F. L. Moll (1), A. Algra (3, 4)
(1) Department of Vascular Surgery, University Medical Center Utrecht, Utrecht , The Netherlands; (2) Department of Vascular Surgery, Hospital Amstelland, Amstelveen, The Netherlands; (3) Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands; (4) Department of Neurology, Rudolf Magnus Institute, University Medical Center Utrecht, The Netherlands
Patients with peripheral arterial disease (PAD) are at high risk of major ischaemic events. Long-term data of all major ischaemic events in PAD patients are scarce and outdated, especially for patients with severe PAD requiring bypass surgery. Our objective was to define their long-term prognosis and develop a prediction model which quantifies this risk up to a decade after surgery. We conducted a retrospective cohort study in patients from the Dutch Bypass Oral anticoagulants or Aspirin (BOA) Study; a multicentre randomised trial comparing oral anticoagulants with aspirin after infrainguinal bypass surgery. The primary outcome was the composite event of non-fatal myocardial infarction, non-fatal ischaemic stroke, major amputation, and vascular death. Cumulative risks were assessed by Kaplan-Meier analysis and independent determinants by multivariable Cox regression models. From 1995 until 2009, 482 patients were followed for a median period of 7.8 years. Follow-up was complete in 94%. Overall 60% of patients experienced a primary outcome event, of which the majority was a vascular death (30%), followed by major amputations (12%). The primary cause of vascular death was a cardiovascular event (29%), whereas the minority was due to complications directly related to PAD (6%). Within five years after bypass surgery vascular death occurred in about a quarter of patients and within 10 years in nearly half of patients. This was double the rate as for non-vascular death. The primary outcome event occurred in over a third and over half of patients in 5 and 10 years after bypass surgery, respectively. From four independent determinants for the primary outcome event: age, diabetes, critical limb ischaemia, and prior vascular interventions, we developed a risk chart, which systematically classifies the 10-year risks of the primary outcome event, ranging from 25% to 85%. This study provided a detailed insight in the course of PAD long after peripheral bypass surgery and enables individual risk assessment of major fatal and non-fatal ischaemic events by means of cumulative incidences and a risk chart.
Prognosis, Atherosclerosis, ischaemia, peripheral artery disease, bypass surgery
K. Kamenica1, Th. Brill4, J. Hirschberger2, R. Köstlin3, W. Hermanns1
Tierärztliche Praxis Kleintiere 2008 36 2: 127-134
Andreas E. May, Tobias Geisler, Meinrad Gawaz
Thromb Haemost 2008 99 3: 487-493
E. Fricke¹, S. Eckert², H. Fricke¹, J. Körfer¹, R. Weise¹, O. Lindner¹, D. Tschöpe3, D. Horstkotte², W. Burchert1
Nuklearmedizin 2008 47 1: 24-29
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