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Sökning: WFRF:(Fowkes F. Gerry R.) > Etiology and outcom...

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FältnamnIndikatorerMetadata
00006769naa a2200553 4500
001oai:DiVA.org:oru-97370
003SwePub
008220209s2022 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-973702 URI
0247 a https://doi.org/10.1016/j.jvs.2021.08.0962 DOI
040 a (SwePub)oru
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Govsyeyev, Nicholasu CPC Clinical Research, Aurora CO, USA; Division of Vascular Surgery, Department of Surgery, University of Colorado Department of Surgery, Aurora CO, USA4 aut
2451 0a Etiology and outcomes of amputation in patients with peripheral artery disease in the EUCLID trial
264 1b Elsevier,c 2022
338 a print2 rdacarrier
500 a Funding agencies:National Institutes of Health/National Center for Advancing Translational Sciences Colorado CTSI UL1 TR002535American Heart Association Strategically Focused Research Network in Vascular Disease 18SFRN3390085 18SFRN33960262
520 a Objective: Amputation remains a frequent and feared outcome in patients with peripheral artery disease (PAD). Although typically characterized as major or minor on the extent of tissue loss, the etiologies and outcomes after amputation by extent are not well-understood. In addition, emerging data suggest that the drivers and outcomes of amputation in patients with PAD may differ in those with and without diabetes mellitus (DM).Methods: The EUCLID trial randomized 13,885 patients with symptomatic PAD, including 5345 with concomitant diabetes, to ticagrelor or clopidogrel and followed them for long-term outcomes. Amputations were prospectively reported by trial investigators. Their primary and contributing drivers were adjudicated using safety data, including infection, ischemia, or multifactorial etiologies. Outcomes following major and minor amputations were analyzed, including recurrent amputation, major adverse limb events, adverse cardiovascular events, and mortality. Multivariable logistic regression models were used to identify independent predictors of minor amputations. Analyses were performed overall and stratified by the presence or absence of DM at baseline.Results: Of the patients randomized, 398 (2.9%) underwent at least one lower extremity nontraumatic amputation, for a total of 511 amputations (255 major and 256 minor) over a median of 30 months. A history of minor amputation was the strongest independent predictor for a subsequent minor amputation (odds ratio, 7.29; 95% confidence interval, 5.17-10.30; P <.001) followed by comorbid DM (odds ratio, 4.60; 95% confidence interval, 3.16-6.69; P <.001). Compared with patients who had a major amputation, those with a minor amputation had similar rates of subsequent major amputation (12.2% vs 13.6%), major adverse limb events (15.1% vs 14.9%), and major adverse cardiovascular events (17.6% vs 16.3%). Ischemia alone was the primary driver of amputation (51%), followed by infection alone (27%), and multifactorial etiologies (22%); however, infection was the most frequent driver in those with DM (58%) but not in those without DM (15%).Conclusions: Outcomes after amputation remain poor regardless of whether they are categorized as major or minor. The pattern of amputation drivers in PAD differs by history of DM, with infection being the dominant etiology in those with DM and ischemia in those without DM. Greater focus is needed on the prognostic importance of minor amputation and of the multifactorial etiologies of amputation in PAD. Nomenclature with anatomical description of amputations and eliminating terms "major" or "minor" would seem appropriate.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
653 a Amputation
653 a Diabetes mellitus
653 a Infection
653 a Lower extremity
653 a Peripheral artery disease
7001 a Nehler, Mark R.u CPC Clinical Research, Aurora CO, USA; Division of Vascular Surgery, Department of Surgery, University of Colorado Department of Surgery, Aurora CO, USA4 aut
7001 a Wang, Cecilia C. Lowu Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora CO, USA4 aut
7001 a Kavanagh, Sarahu CPC Clinical Research, Aurora CO, USA4 aut
7001 a Hiatt, William R.u CPC Clinical Research, Aurora CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora CO, USA4 aut
7001 a Long, Chandleru Duke University Medical Center, Durham NC, USA4 aut
7001 a Jones, W. Schuyleru Duke University Medical Center, Durham NC, USA4 aut
7001 a Fowkes, F. Gerry R.u Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland4 aut
7001 a Berger, Jeffrey S.u NYU School of Medicine, New York NY, USA4 aut
7001 a Baumgartner, Irisu Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland4 aut
7001 a Patel, Manesh R.u Duke University Medical Center, Durham NC, USA4 aut
7001 a Goodney, Philip P.u Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA4 aut
7001 a Beckman, Joshua A.u Division of Cardiovascular Medicine, Department of Medicine, Nashville TN, USA4 aut
7001 a Katona, Brian G.u Astra Zeneca, Gaithersburg MD, USA4 aut
7001 a Mahaffey, Kenneth W.u Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford CA, USA4 aut
7001 a Blomster, Juusou Department of Medicine, University of Turku, Turku, Finland4 aut
7001 a Norgren, Lars,d 1942-u Örebro universitet,Institutionen för humaniora, utbildnings- och samhällsvetenskap,Department of Surgery4 aut0 (Swepub:oru)lsnn
7001 a Bonaca, Marc P.u CPC Clinical Research, Aurora CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora CO, USA4 aut
7102 a CPC Clinical Research, Aurora CO, USA; Division of Vascular Surgery, Department of Surgery, University of Colorado Department of Surgery, Aurora CO, USAb Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora CO, USA4 org
7730 t Journal of Vascular Surgeryd : Elsevierg 75:2, s. 660-670e3q 75:2<660-670e3x 0741-5214x 1097-6809
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-97370
8564 8u https://doi.org/10.1016/j.jvs.2021.08.096

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