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Immediate results and long-term cardiovascular outcomes of endovascular therapy in octogenarians and nonoctogenarians with peripheral arterial diseases.

Huang HL, Jimmy Juang JM, Chou HH, Hsieh CA, Jang SJ, Cheng ST, Ko YL - Clin Interv Aging (2016)

Bottom Line: Immediate results and long-term vascular outcomes were analyzed and compared between octogenarians and nonoctogenarians.In Cox regression analysis, dependence on dialysis and AF were significant predictors of death (odds ratio [OR] 4.44 in dialyzed and 2.83 in AF patients), major cerebrovascular and cardiovascular events (OR 3.49 and 2.45), and composite vascular events (OR 3.14 and 2.25).However, these observations require further confirmation in larger scale studies.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.

ABSTRACT

Purpose: To investigate the clinical outcomes of endovascular therapy (EVT) in octogenarians and nonoctogenarians with peripheral arterial disease.

Methods: A retrospective analysis of 511 patients (654 affected legs) who underwent EVT between July 2005 and December 2013 was conducted in a prospectively maintained database. Immediate results and long-term vascular outcomes were analyzed and compared between octogenarians and nonoctogenarians.

Results: Octogenarians were more likely to be female and have atrial fibrillation (AF), whereas nonoctogenarians had higher rates of obesity, claudication, and medical comorbidities. There were no differences in the rates of EVT success, 30-day major adverse vascular events, and 6-month functional improvement between groups. Over the 10-year follow-up period, the rates of 3-year limb salvage, sustained clinical success, freedom from major cerebrovascular and cardiovascular events, and composite vascular events were similar between groups, but the survival rate was better in nonoctogenarians than in octogenarians (73% vs 63%, respectively, P=0.004). In Cox regression analysis, dependence on dialysis and AF were significant predictors of death (odds ratio [OR] 4.44 in dialyzed and 2.83 in AF patients), major cerebrovascular and cardiovascular events (OR 3.49 and 2.45), and composite vascular events (OR 3.14 and 2.25).

Conclusion: EVT in octogenarians was feasible, without an increased risk of periprocedural complications. The rates of limb salvage, sustained clinical success, and long-term vascular events were comparable between groups. Dialysis dependence and AF are independent predictors for poor prognosis in patients with peripheral arterial disease. However, these observations require further confirmation in larger scale studies.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier curves for freedom from major cerebrovascular and cardiovascular events (MACCEs).Notes: The rates of 3-year freedom from MACCEs were similar between groups (50% in octogenarians vs 55% in nonoctogenarians, P=0.564). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.
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f3-cia-11-535: Kaplan–Meier curves for freedom from major cerebrovascular and cardiovascular events (MACCEs).Notes: The rates of 3-year freedom from MACCEs were similar between groups (50% in octogenarians vs 55% in nonoctogenarians, P=0.564). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.

Mentions: Over a mean follow-up period of 34±25 months (range 3–112), 157 patients died (50 in octogenarians and 107 in nonoctogenarians), and the rates of overall survival in both groups were significantly different at 3 (63% vs 73%) and 5 years (45% vs 67%, P=0.004) (Figure 2). There were no significant differences between groups in the rates of limb salvage (91% vs 87%, P=0.07) and SCS at 3 years (51% vs 47%, P=0.297). The rates of freedom from cardiovascular death (84% vs 89%, P=0.122), nonfatal cardiovascular events (78% vs 73%, P=0.121), and stroke (86% vs 87%, P=0.504) at 3 years were similar between groups. More octogenarians died owing to noncardiovascular problems, mainly from sepsis followed by malignancy. There were no between-group differences at 3 years in the rates of freedom from MACCEs (50% vs 55%, P=0.47) or CVEs (63% vs 61%, P=0.38) (Figures 3 and 4). However, non-octogenarians had higher rates of nonfatal MI during the follow-up period compared with octogenarians (19% vs 8%, P=0.049). Multivariate analysis showed that the octogenarian factor was not significantly associated with MACCEs or CVEs. Dialysis dependence and AF were strong independent predictors of overall survival (OR 4.44; 95% CI 1.79–11.1; P=0.001 and OR 2.83; 95% CI 1.49–5.35; P=0.001, respectively), MACCE (OR 3.49; 95% CI 1.48–8.19; P=0.004 and OR 2.45; 95% CI 1.31–4.45; P=0.005, respectively), and CVE (OR 3.14; 95% CI 1.32–7.48; P=0.009 and OR 2.25; 95% CI 1.21–4.17; P=0.010, respectively) (Table 4).


Immediate results and long-term cardiovascular outcomes of endovascular therapy in octogenarians and nonoctogenarians with peripheral arterial diseases.

Huang HL, Jimmy Juang JM, Chou HH, Hsieh CA, Jang SJ, Cheng ST, Ko YL - Clin Interv Aging (2016)

Kaplan–Meier curves for freedom from major cerebrovascular and cardiovascular events (MACCEs).Notes: The rates of 3-year freedom from MACCEs were similar between groups (50% in octogenarians vs 55% in nonoctogenarians, P=0.564). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862757&req=5

f3-cia-11-535: Kaplan–Meier curves for freedom from major cerebrovascular and cardiovascular events (MACCEs).Notes: The rates of 3-year freedom from MACCEs were similar between groups (50% in octogenarians vs 55% in nonoctogenarians, P=0.564). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.
Mentions: Over a mean follow-up period of 34±25 months (range 3–112), 157 patients died (50 in octogenarians and 107 in nonoctogenarians), and the rates of overall survival in both groups were significantly different at 3 (63% vs 73%) and 5 years (45% vs 67%, P=0.004) (Figure 2). There were no significant differences between groups in the rates of limb salvage (91% vs 87%, P=0.07) and SCS at 3 years (51% vs 47%, P=0.297). The rates of freedom from cardiovascular death (84% vs 89%, P=0.122), nonfatal cardiovascular events (78% vs 73%, P=0.121), and stroke (86% vs 87%, P=0.504) at 3 years were similar between groups. More octogenarians died owing to noncardiovascular problems, mainly from sepsis followed by malignancy. There were no between-group differences at 3 years in the rates of freedom from MACCEs (50% vs 55%, P=0.47) or CVEs (63% vs 61%, P=0.38) (Figures 3 and 4). However, non-octogenarians had higher rates of nonfatal MI during the follow-up period compared with octogenarians (19% vs 8%, P=0.049). Multivariate analysis showed that the octogenarian factor was not significantly associated with MACCEs or CVEs. Dialysis dependence and AF were strong independent predictors of overall survival (OR 4.44; 95% CI 1.79–11.1; P=0.001 and OR 2.83; 95% CI 1.49–5.35; P=0.001, respectively), MACCE (OR 3.49; 95% CI 1.48–8.19; P=0.004 and OR 2.45; 95% CI 1.31–4.45; P=0.005, respectively), and CVE (OR 3.14; 95% CI 1.32–7.48; P=0.009 and OR 2.25; 95% CI 1.21–4.17; P=0.010, respectively) (Table 4).

Bottom Line: Immediate results and long-term vascular outcomes were analyzed and compared between octogenarians and nonoctogenarians.In Cox regression analysis, dependence on dialysis and AF were significant predictors of death (odds ratio [OR] 4.44 in dialyzed and 2.83 in AF patients), major cerebrovascular and cardiovascular events (OR 3.49 and 2.45), and composite vascular events (OR 3.14 and 2.25).However, these observations require further confirmation in larger scale studies.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.

ABSTRACT

Purpose: To investigate the clinical outcomes of endovascular therapy (EVT) in octogenarians and nonoctogenarians with peripheral arterial disease.

Methods: A retrospective analysis of 511 patients (654 affected legs) who underwent EVT between July 2005 and December 2013 was conducted in a prospectively maintained database. Immediate results and long-term vascular outcomes were analyzed and compared between octogenarians and nonoctogenarians.

Results: Octogenarians were more likely to be female and have atrial fibrillation (AF), whereas nonoctogenarians had higher rates of obesity, claudication, and medical comorbidities. There were no differences in the rates of EVT success, 30-day major adverse vascular events, and 6-month functional improvement between groups. Over the 10-year follow-up period, the rates of 3-year limb salvage, sustained clinical success, freedom from major cerebrovascular and cardiovascular events, and composite vascular events were similar between groups, but the survival rate was better in nonoctogenarians than in octogenarians (73% vs 63%, respectively, P=0.004). In Cox regression analysis, dependence on dialysis and AF were significant predictors of death (odds ratio [OR] 4.44 in dialyzed and 2.83 in AF patients), major cerebrovascular and cardiovascular events (OR 3.49 and 2.45), and composite vascular events (OR 3.14 and 2.25).

Conclusion: EVT in octogenarians was feasible, without an increased risk of periprocedural complications. The rates of limb salvage, sustained clinical success, and long-term vascular events were comparable between groups. Dialysis dependence and AF are independent predictors for poor prognosis in patients with peripheral arterial disease. However, these observations require further confirmation in larger scale studies.

No MeSH data available.


Related in: MedlinePlus