Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 72, Issue 14, Pages 1563-1572Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2018.07.046
Keywords
acute limb ischemia; cardiovascular event; diabetes; lower extremity revascularization; peripheral artery disease; smoking
Categories
Funding
- AstraZeneca
- Abbott Vascular
- Cook
- Terumo
- Amgen
- Boston Scientific
- Bayer
- AnGes
- Mitsubishi
- Pluristem
- CESCA Therapeutics
- CSL Behring
- HeartFlow
- Janssen Research
- National Heart, Lung, and Blood Institute
- American Heart Association
- Janssen
- Merck
- Takeda
- Afferent
- Apple, Inc.
- Cardiva Medical, Inc.
- Daiichi
- Google (Verily)
- Johnson Johnson
- Luitpold
- Medtronic
- Novartis
- Sanofi
- St. Jude
- Tenax
- National Institutes of Health
- Ferring
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BACKGROUND Lower extremity revascularization (LER) is a common treatment in patients with peripheral artery disease (PAD), but long-term outcomes are poorly defined. OBJECTIVES The aim was to analyze LER in the EUCLID (Examining Use of tiCagreLor In paD) trial to determine predictors and cardiovascular outcomes. METHODS Patients were grouped according to whether they received a post-randomization LER (n = 1,738) or not (n = 12,147). All variables were assessed for significance in univariable and parsimonious multivariable models. The primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death; major adverse limb events (MALE) included acute limb ischemia or major amputation. RESULTS A post-randomization LER occurred in 12.5% of patients and was an endovascular LER in 74.7%. Endovascular LERs were performed more often in North America, whereas surgical procedures occurred more frequently in Europe. Independent factors predicting LER were prior and type of prior LER, geographic region, limb symptoms, diabetes, and smoking. A post-randomization LER was associated with an increased risk for the primary endpoint (hazard ratio: 1.60; 95% confidence interval: 1.35 to 1.90; p < 0.0001) and MALE (hazard ratio: 12.0; 95% confidence interval: 9.47 to 15.30; p < 0.0001). Event rates for the primary endpoint after LER were numerically higher in the surgical subgroup, but MALE were similar between surgical and endovascular LER. CONCLUSIONS In the EUCLID trial, LER was most often endovascular. Following LER, there was an increased hazard for the primary endpoint (with higher event rates in the surgical group) and a markedly increased risk for MALE events (with similar event rates between surgical and endovascular LER procedures). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822) (J Am Coll Cardiol 2018; 72: 1563-72) (C) 2018 by the American College of Cardiology Foundation.
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