Circulation. Cardiovascular interventions · 2025
Age-Related Outcomes After Revascularization for Chronic Limb-Threatening Ischemia: An Analysis of BEST-CLI.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Shah Khanjan B, Aridi Hanaa, Dake Michael D, Doros Gheorghe, Farber Alik, Menard Matthew T, Motaganahalli Raghu, Ochoa Chaar Cassius, Rosenfield Kenneth, Scali Salvatore T, Shah Samir K, Strong Michael B, Upchurch Gilbert R, Robinson William P
Аннотация
BACKGROUND: The impact of age on outcomes after revascularization for chronic limb-threatening ischemia has not been studied in a prospective trial.
METHODS: A total of 1780 patients were grouped into age quartiles (≤55 years, 55< age ≤65 years, 65< age ≤75 years, and >75 years) and by type of revascularization (open bypass or endovascular). The primary outcome was major adverse limb events (MALE) or death, and the secondary outcomes were above-ankle amputation, reintervention, and major adverse cardiovascular events.
RESULTS: Death and major adverse cardiovascular events were significantly higher in the oldest quartile (>75 years), whereas MALE and above-ankle amputation were highest in the youngest cohort (≤55 years). Younger patients (≤55 years) had the lowest adjusted risk of MALE or all-cause death with open bypass compared with endovascular revascularization. There was no difference in MALE or all-cause death by treatment strategy in patients >75 years of age.
CONCLUSIONS: Older age was associated with the highest risks of death and major adverse cardiovascular events and the lowest risks of MALE and above-ankle amputation among patients enrolled in BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Chronic Limb-Threatening Ischemia). Age also had a differential impact by revascularization strategy: youngest patients had the lowest risk of MALE and all-cause death with bypass surgery compared with endovascular revascularization, while there was no difference among those >75 years. These data should be used to facilitate shared decision-making in patients with chronic limb-threatening ischemia.
REGISTRATION: URL: https://biolincc.nhlbi.nih.gov/studies/best_cli/; Unique identifier: HLB02932424a.
METHODS: A total of 1780 patients were grouped into age quartiles (≤55 years, 55< age ≤65 years, 65< age ≤75 years, and >75 years) and by type of revascularization (open bypass or endovascular). The primary outcome was major adverse limb events (MALE) or death, and the secondary outcomes were above-ankle amputation, reintervention, and major adverse cardiovascular events.
RESULTS: Death and major adverse cardiovascular events were significantly higher in the oldest quartile (>75 years), whereas MALE and above-ankle amputation were highest in the youngest cohort (≤55 years). Younger patients (≤55 years) had the lowest adjusted risk of MALE or all-cause death with open bypass compared with endovascular revascularization. There was no difference in MALE or all-cause death by treatment strategy in patients >75 years of age.
CONCLUSIONS: Older age was associated with the highest risks of death and major adverse cardiovascular events and the lowest risks of MALE and above-ankle amputation among patients enrolled in BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Chronic Limb-Threatening Ischemia). Age also had a differential impact by revascularization strategy: youngest patients had the lowest risk of MALE and all-cause death with bypass surgery compared with endovascular revascularization, while there was no difference among those >75 years. These data should be used to facilitate shared decision-making in patients with chronic limb-threatening ischemia.
REGISTRATION: URL: https://biolincc.nhlbi.nih.gov/studies/best_cli/; Unique identifier: HLB02932424a.
Предметные рубрики MeSH
HumansMaleAgedFemaleMiddle AgedPeripheral Arterial DiseaseIschemiaRisk FactorsTreatment OutcomeAmputation, SurgicalEndovascular ProceduresAge FactorsChronic DiseaseTime FactorsRisk AssessmentProspective StudiesLimb SalvageVascular Surgical ProceduresAged, 80 and overChronic Limb-Threatening Ischemia