Predictors of mortality in patients with lower extremity peripheral arterial disease: 5-year follow-up

Zehra Jaffery, Adam B. Greenbaum, Mohammad F. Siddiqui, Neetu Mahendraker, Vikesh Gupta, Vidu Mokkala, Uday Kanakadandi, Andrew Robbins, James McCord

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long-term survival benefits of LE arterial revascularization. Methods: Two hundred and eighty-three patients with an ankle brachial index (ABI) ≤0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all-cause mortality were measured at 5 years. Results: Of 283 patients identified, 42 (15%) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26%) patients underwent repeat procedures over the 5 years of follow-up. Those undergoing revascularization were more often Caucasian (95% vs. 79%, P = 0.01) and had lower ABIs (ABI ≤ 0.4, 45% vs. 17%, P = <0.001). At 44 ± 19 months follow-up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24%) versus 107/241 (44%) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all-cause mortality (HR 0.51 [95% CI 0.26-1.02], P = 0.056). Independent predictors of mortality were age ≥65 years (HR 2.42 [95% CI 1.52-3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95% CI 1.13-2.46], P = 0.010), chronic kidney disease (HR 1.75 [95% CI 1.15-2.67], P = 0.010), and an ABI ≤ 0.4 (HR 1.88 [95% CI 1.19-2.96], P = 0.006). Conclusion: Few patients at this center with LE-PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5-year mortality in those undergoing LE arterial revascularization when compared to those who do not.

Original languageEnglish
Pages (from-to)564-570
Number of pages7
JournalJournal of Interventional Cardiology
Volume22
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

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Peripheral Arterial Disease
Lower Extremity
Mortality
Ankle Brachial Index
Veterans Hospitals
United States Department of Veterans Affairs
Chronic Renal Insufficiency
Coronary Artery Disease
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Jaffery, Z., Greenbaum, A. B., Siddiqui, M. F., Mahendraker, N., Gupta, V., Mokkala, V., ... McCord, J. (2009). Predictors of mortality in patients with lower extremity peripheral arterial disease: 5-year follow-up. Journal of Interventional Cardiology, 22(6), 564-570. https://doi.org/10.1111/j.1540-8183.2009.00505.x

Predictors of mortality in patients with lower extremity peripheral arterial disease : 5-year follow-up. / Jaffery, Zehra; Greenbaum, Adam B.; Siddiqui, Mohammad F.; Mahendraker, Neetu; Gupta, Vikesh; Mokkala, Vidu; Kanakadandi, Uday; Robbins, Andrew; McCord, James.

In: Journal of Interventional Cardiology, Vol. 22, No. 6, 12.2009, p. 564-570.

Research output: Contribution to journalArticle

Jaffery, Z, Greenbaum, AB, Siddiqui, MF, Mahendraker, N, Gupta, V, Mokkala, V, Kanakadandi, U, Robbins, A & McCord, J 2009, 'Predictors of mortality in patients with lower extremity peripheral arterial disease: 5-year follow-up', Journal of Interventional Cardiology, vol. 22, no. 6, pp. 564-570. https://doi.org/10.1111/j.1540-8183.2009.00505.x
Jaffery, Zehra ; Greenbaum, Adam B. ; Siddiqui, Mohammad F. ; Mahendraker, Neetu ; Gupta, Vikesh ; Mokkala, Vidu ; Kanakadandi, Uday ; Robbins, Andrew ; McCord, James. / Predictors of mortality in patients with lower extremity peripheral arterial disease : 5-year follow-up. In: Journal of Interventional Cardiology. 2009 ; Vol. 22, No. 6. pp. 564-570.
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abstract = "Background: Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long-term survival benefits of LE arterial revascularization. Methods: Two hundred and eighty-three patients with an ankle brachial index (ABI) ≤0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all-cause mortality were measured at 5 years. Results: Of 283 patients identified, 42 (15{\%}) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26{\%}) patients underwent repeat procedures over the 5 years of follow-up. Those undergoing revascularization were more often Caucasian (95{\%} vs. 79{\%}, P = 0.01) and had lower ABIs (ABI ≤ 0.4, 45{\%} vs. 17{\%}, P = <0.001). At 44 ± 19 months follow-up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24{\%}) versus 107/241 (44{\%}) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all-cause mortality (HR 0.51 [95{\%} CI 0.26-1.02], P = 0.056). Independent predictors of mortality were age ≥65 years (HR 2.42 [95{\%} CI 1.52-3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95{\%} CI 1.13-2.46], P = 0.010), chronic kidney disease (HR 1.75 [95{\%} CI 1.15-2.67], P = 0.010), and an ABI ≤ 0.4 (HR 1.88 [95{\%} CI 1.19-2.96], P = 0.006). Conclusion: Few patients at this center with LE-PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5-year mortality in those undergoing LE arterial revascularization when compared to those who do not.",
author = "Zehra Jaffery and Greenbaum, {Adam B.} and Siddiqui, {Mohammad F.} and Neetu Mahendraker and Vikesh Gupta and Vidu Mokkala and Uday Kanakadandi and Andrew Robbins and James McCord",
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T1 - Predictors of mortality in patients with lower extremity peripheral arterial disease

T2 - 5-year follow-up

AU - Jaffery, Zehra

AU - Greenbaum, Adam B.

AU - Siddiqui, Mohammad F.

AU - Mahendraker, Neetu

AU - Gupta, Vikesh

AU - Mokkala, Vidu

AU - Kanakadandi, Uday

AU - Robbins, Andrew

AU - McCord, James

PY - 2009/12

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N2 - Background: Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long-term survival benefits of LE arterial revascularization. Methods: Two hundred and eighty-three patients with an ankle brachial index (ABI) ≤0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all-cause mortality were measured at 5 years. Results: Of 283 patients identified, 42 (15%) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26%) patients underwent repeat procedures over the 5 years of follow-up. Those undergoing revascularization were more often Caucasian (95% vs. 79%, P = 0.01) and had lower ABIs (ABI ≤ 0.4, 45% vs. 17%, P = <0.001). At 44 ± 19 months follow-up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24%) versus 107/241 (44%) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all-cause mortality (HR 0.51 [95% CI 0.26-1.02], P = 0.056). Independent predictors of mortality were age ≥65 years (HR 2.42 [95% CI 1.52-3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95% CI 1.13-2.46], P = 0.010), chronic kidney disease (HR 1.75 [95% CI 1.15-2.67], P = 0.010), and an ABI ≤ 0.4 (HR 1.88 [95% CI 1.19-2.96], P = 0.006). Conclusion: Few patients at this center with LE-PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5-year mortality in those undergoing LE arterial revascularization when compared to those who do not.

AB - Background: Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long-term survival benefits of LE arterial revascularization. Methods: Two hundred and eighty-three patients with an ankle brachial index (ABI) ≤0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all-cause mortality were measured at 5 years. Results: Of 283 patients identified, 42 (15%) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26%) patients underwent repeat procedures over the 5 years of follow-up. Those undergoing revascularization were more often Caucasian (95% vs. 79%, P = 0.01) and had lower ABIs (ABI ≤ 0.4, 45% vs. 17%, P = <0.001). At 44 ± 19 months follow-up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24%) versus 107/241 (44%) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all-cause mortality (HR 0.51 [95% CI 0.26-1.02], P = 0.056). Independent predictors of mortality were age ≥65 years (HR 2.42 [95% CI 1.52-3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95% CI 1.13-2.46], P = 0.010), chronic kidney disease (HR 1.75 [95% CI 1.15-2.67], P = 0.010), and an ABI ≤ 0.4 (HR 1.88 [95% CI 1.19-2.96], P = 0.006). Conclusion: Few patients at this center with LE-PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5-year mortality in those undergoing LE arterial revascularization when compared to those who do not.

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