Annals of vascular surgery · 2025
Clinical Outcomes in Patients with Chronic Limb-Threatening Ischemia with or Without Hyperpolypharmacy After Revascularization.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Kobayashi Taira, Mukai Kazuki, Katayama Yuichiro, Ide Toshie, Tochigi Sayaka, Okazaki Takanobu, Okusako Ryo, Hamamoto Masaki, Hasegawa Misa, Fujii Hina, Takahashi Shinya
Аннотация
BACKGROUND: Polypharmacy (PP) or hyperpolypharmacy (HP) in elderly patients has been associated with poor prognosis and cardiovascular events due to side effects and drug interactions. Patients with chronic limb-threatening ischemia (CLTI) have many comorbidities that may need multiple drugs. The purpose of this study is to evaluate clinical outcomes in these patients with or without HP.
METHODS: Patients who underwent initial revascularization for CLTI between 2014 and 2022 at a single center were evaluated retrospectively. Comparisons were made between patients with no PP (< 5 prescription drugs) or PP (5-9 prescription drugs) (no hyperpolypharmacy [NHP] group) and HP (≥ 10 prescription drugs) (HP group) after revascularization. The primary outcomes were overall survival (OS) and risk factors affecting survival.
RESULTS: There were 193 patients (21 [5%] without PP and 172 [41%] with PP) in the NHP group (46%) and 224 (53%) in the HP group. The median number of drugs was 10 (7-13). During a mean follow-up period of 32.0 ± 28.3 months, 182 patients died. Using the Kaplan-Meier method, the 1-year, 3-year, and 5-year OS rates of 79.9%, 50.0%, and 35.1%, respectively, in the HP group were significantly lower than those in the NHP group (P < 0.001). Freedom from cardiovascular death (P < 0.001) and limb salvage (P = 0.010) were also lower in the HP group. In multivariate analysis, death was independently associated with HP (hazard ratio, 1.60; 95% confidence interval, 1.14-2.25; P = 0.007).
CONCLUSION: HP in patients with CLTI after revascularization was negatively associated with OS, freedom from cardiovascular death, and limb salvage.
METHODS: Patients who underwent initial revascularization for CLTI between 2014 and 2022 at a single center were evaluated retrospectively. Comparisons were made between patients with no PP (< 5 prescription drugs) or PP (5-9 prescription drugs) (no hyperpolypharmacy [NHP] group) and HP (≥ 10 prescription drugs) (HP group) after revascularization. The primary outcomes were overall survival (OS) and risk factors affecting survival.
RESULTS: There were 193 patients (21 [5%] without PP and 172 [41%] with PP) in the NHP group (46%) and 224 (53%) in the HP group. The median number of drugs was 10 (7-13). During a mean follow-up period of 32.0 ± 28.3 months, 182 patients died. Using the Kaplan-Meier method, the 1-year, 3-year, and 5-year OS rates of 79.9%, 50.0%, and 35.1%, respectively, in the HP group were significantly lower than those in the NHP group (P < 0.001). Freedom from cardiovascular death (P < 0.001) and limb salvage (P = 0.010) were also lower in the HP group. In multivariate analysis, death was independently associated with HP (hazard ratio, 1.60; 95% confidence interval, 1.14-2.25; P = 0.007).
CONCLUSION: HP in patients with CLTI after revascularization was negatively associated with OS, freedom from cardiovascular death, and limb salvage.
Предметные рубрики MeSH
HumansRetrospective StudiesMaleFemalePolypharmacyAgedIschemiaPeripheral Arterial DiseaseRisk FactorsTime FactorsChronic DiseaseLimb SalvageAged, 80 and overRisk AssessmentTreatment OutcomeMiddle AgedAmputation, SurgicalVascular Surgical ProceduresChronic Limb-Threatening IschemiaComorbidityEndovascular Procedures