Long-Term and Time-Dependent Association of Predictors on Mortality in Patients With Iliofemoral Artery Disease.

Abstract

Background: Although several predictors affect long-term mortality in patients with lower extremity artery disease, long-term association of predictors on mortality over time remain unclear.

Objectives: The aim of this study was to explore the long-term and time-dependent association of baseline characteristics with mortality in patients with iliofemoral arterial disease.

Methods: This study is a multicenter retrospective analysis of 4,086 consecutive patients (mean age 72 ± 9 years, 74% men) who underwent endovascular therapy for symptomatic de novo iliofemoral arterial disease between January 2004 and December 2011 at 16 cardiovascular centers in Japan.

Results: During the median follow-up of 3.8 years (Q1-Q3: 1.4-7.4 years), 1,100 deaths, and 637 major adverse cardiovascular events (MACE) (defined as death, myocardial infarction, and stroke) were observed. Overall survival and MACE-free rates were estimated to be 56.1% and 50.6% at 10 years. Old age, chronic kidney disease stage, heart failure, the lack of renin-angiotensin-system inhibitor use, chronic limb threatening ischemia (CLTI), decreased ankle-brachial index, femoropopliteal lesion were significantly associated with an increased risk of mortality. while the prognostic impact of CLTI was significantly attenuated afterwards. Old age, chronic kidney disease stage, cerebrovascular disease, coronary artery disease, heart failure, warfarin use, the lack of statin use, and CLTI were significantly associated with an increased risk of MACE, while the prognostic impact of cerebrovascular disease and CLTI was significantly attenuated afterwards.

Conclusions: This study demonstrated long-term and time-dependent association of predictors on mortality and MACE following endovascular therapy. It highlights the need for continuous management of cardiovascular risk factors in this high-risk population.