Outcomes and Characteristics of Patients Undergoing Percutaneous Angioplasty Followed by Below-Knee or Above-Knee Amputation for Peripheral Artery Disease |
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Authors: | Chun-Tai Mao Ming-Lung Tsai Chao-Yung Wang Ming-Shien Wen I-Chang Hsieh Ming-Jui Hung Chao-Hung Wang Chun-Chi Chen Tien-Hsing Chen |
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Affiliation: | 1. Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.; 2. Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.; 3. Department of cardiology, Chang Gung Memorial Hospital, Xiamen, China.; 4. College of Medicine, Chang Gung University, Taoyuan, Taiwan.; Osaka University Graduate School of Medicine, Japan, |
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Abstract: | ObjectiveLittle is known about long-term outcomes among patients who receive percutaneous angioplasty (PTA) for peripheral artery disease (PAD) then undergo below-knee or above-knee amputations. We sought to determine clinical outcomes associated with below-knee or above-knee amputation, along with possible explanatory factors and treatment strategies.MethodsUsing data from Taiwan’s National Health Insurance Research Database from 1997 to 2010, 7,568 adult patients were divided into three groups: lower extremity preserved (LE), below-knee amputation (BK) and above-knee amputation (AK). We assessed outcomes including major adverse cardiovascular events (MACE) and associated risk factors.ResultsOverall MACE was significantly higher in the AK group compared to the LE and BK groups, over a mean follow-up of 2.45 years (hazard ratio [HR]: 1.81; 95% confidence interval [CI]: 1.50–2.18 for AK vs. LE; HR: 1.67; 95% CI: 1.36–2.06 for AK vs. BK). However MACE were similar for the BK and LE groups (HR: 1.08; 95% CI: 0.98–1.20). Overall mortality was highest in the AK group (HR: 1.65, 95% CI: 1.34–2.04 for AK vs. BK). As for patient characteristics, atrial fibrillation was more prevalent in the AK group than in the BK group (17% vs. 7%). Independent risk factors associated with death after above- or below-knee amputation included advanced age, heart failure, dialysis, male gender and high patient volume.ConclusionThe MACE rate was highest in the AK group, whereas the LE and BK groups were similar in this regard. Furthermore, overall mortality increased with larger area of amputation. |
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