Endovascular Treatment of Infrainguinal Peripheral Artery Disease With Stent Versus Nonstent Strategies in the XLPAD Registry

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-04-08 DOI:10.1016/j.amjcard.2025.04.002

Subhash Banerjee MD , David Fernandez Vazquez MD , Yu-Lun Liu PhD , Sameh Sayfo MD , Minseob Jeong MD , Zachary P. Rosol MD , Anand Gupta MBBS, MPH , Blake M. Bruneman BS , Sarah G. Weideman BS , Kennedy S. Adelman BS , Shirling Tsai MD , Shuaib Abdullah MD , Hung B. Chu MD, RPVI , Bertram L. Smith MD , Bradley R. Grimsley MD , Stephen E. Hohmann MD , Javier Vasquez Jr MD , Chris Metzger MD , Christopher L. Henry MD , Mujtaba M. Ali MD , John F. Eidt MD

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引用次数: 0

Abstract

Anatomic location of infrainguinal peripheral arteries has continually challenged endovascular revascularization strategies based on the use of stent vs. nonstent strategies. The objective of our study is to compare stent vs. nonstent outcomes of patients enrolled in the multicenter, core laboratory adjudicated XLPAD registry (NCT01904851) between 2005 and 2023. We analyzed 12-month cumulative incidence of major adverse cardiac and vascular events (MACVE), a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, lower limb revascularization and any amputation in patients treated with clinically indicated stent or nonstent interventions, analyzed within a competing risk framework; group differences assessed using the Gray’s test. To minimize confounding bias, we also implemented propensity score matching. About 5,067 patients (5,876 lesions), mean age 67.2 ± 10.3 years, underwent stent (n = 2,571) or nonstent (n = 2,496) predominantly femoropopliteal artery (68%) interventions. 42.8% were current smokers, 57.3% diabetic; 17% had chronic kidney disease and 56.5% coronary artery disease. 50.7% presented with Rutherford class (II-III) symptoms, with mean ankle-brachial index 0.64 ± 0.24. 61% lesions in stent group and 38.6% in the nonstent group had chronic total occlusions (p <0.001). Significantly greater calcified (36.6% vs. 33%; p = 0.004) and longer lesions (142.9 ± 96.5 mm vs. 115.8 ± 91.3 mm; p <0.001) were treated in the stented group. Drug-coated balloon and atherectomy use were 18% and 34.2%, respectively. Procedural success was higher in the stent group (96.9% vs. 89.5%; p <0.001). Peri-procedural period flow-limiting dissections were higher in the stent (2.7% vs. 0.3%; p <0.001), and any amputation in the nonstent (3.0% vs. 4.4%; p = 0.008). 12-month MACVE was higher in the stent group (22.2% vs. 19.2%, p = 0.009) mainly driven by greater need for repeat endovascular revascularization (13.1% vs. 10.4%, p = 0.003), and this was consistent even after adjusting for chronic limb threatening ischemia presentation (adjusted odds ratio [OR], 1.193; 95% confidence interval [CI], 1.039 to 1.370; p = 0.013). The stented group had 29.6% increased odds of MACVE compared to nonstent (adjusted OR, 1.296, 95% CI: 1.115 to 1.506, p = 0.001), even after adjusting for residual confounders with propensity matching. Stent-based interventions are used to treat more complex infrainguinal PAD, with greater procedural success, but higher 12-month MACVE compared with nonstent interventions.

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血管内治疗腹股沟下外周动脉疾病的支架与非支架策略在XLPAD注册

腹股沟下外周动脉的解剖位置不断挑战基于支架与非支架策略的血管内血运重建策略。本研究的目的是比较2005年至2023年在多中心、核心实验室评审的XLPAD注册中心（NCT01904851）登记的患者的支架和非支架结果。我们分析了12个月的主要心脏和血管不良事件（MACVE）累积发生率，这是一项综合结果，包括全因死亡、非致死性心肌梗死、中风、下肢血运重建术和任何截肢，在竞争风险框架内进行分析；使用格雷测试评估组间差异。为了尽量减少混杂偏差，我们还实施了倾向得分匹配。约5067例患者（5876个病变），平均年龄67.2±10.3岁，接受支架（2571例）或非支架（2496例）主要为股腘动脉介入治疗（68%）。42.8%为吸烟者，57.3%为糖尿病患者；17%患有慢性肾脏疾病，56.5%患有冠状动脉疾病。50.7%表现为Rutherford （II-III）级症状，平均踝肱指数0.64±0.24。支架组61%病变发生慢性全闭塞，非支架组38.6%病变发生慢性全闭塞（p <0.001）。明显增加钙化(36.6% vs. 33%；P = 0.004)和更长的病变(142.9±96.5 mm vs 115.8±91.3 mm；P <0.001)。药物包被球囊和动脉粥样硬化切除术的使用率分别为18%和34.2%。支架组手术成功率更高(96.9% vs 89.5%；p & lt; 0.001)。围手术期支架组的限流夹层发生率更高(2.7% vs. 0.3%；P <0.001)，非支架内任何截肢(3.0% vs. 4.4%；P = 0.008)。支架组12个月MACVE较高（22.2% vs. 19.2%, p = 0.009），这主要是由于更需要重复血管内重建（13.1% vs. 10.4%, p = 0.003），即使在调整慢性肢体威胁缺血表现后也是如此(校正优势比[OR]， 1.193；95%置信区间[CI]， 1.039 ~ 1.370；P = 0.013)。与未支架组相比，支架组的MACVE发生率增加了29.6%（校正OR为1.296,95% CI: 1.115至1.506,p = 0.001），即使在调整了倾向匹配的残留混杂因素后也是如此。基于支架的干预用于治疗更复杂的腹股沟下PAD，手术成功率更高，但与非支架干预相比，12个月MACVE更高。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.