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Association between health status and long‐term mortality after percutaneous revascularization of peripheral artery disease
Author(s) -
Bunte Matthew C.,
House John A.,
Spertus John A.,
Cohen David J.,
Marso Steven P.,
Safley David M.
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26442
Subject(s) - medicine , hazard ratio , revascularization , disease , prospective cohort study , diabetes mellitus , proportional hazards model , arterial disease , percutaneous , surgery , vascular disease , confidence interval , myocardial infarction , endocrinology
Objectives To explore the association of health status change and long‐term survival among patients with symptomatic peripheral artery disease (PAD). Background Early gains in health status after successful endovascular therapy (EVT) for symptomatic PAD can be maintained up to 1 year. Whether such health status improvements are associated with long‐term survival benefits is unknown. Methods Between February 2001 and August 2004, 258 patients with symptomatic PAD treated with EVT participated in a prospective study evaluating baseline and 1 year health status using the Peripheral Artery Questionnaire (range 0–100, higher scores = better). All‐cause mortality was assessed for all patients at a median of 9.4 years following EVT. Results The mean age at enrollment was 68 ± 11 years; 61% were male, 97% were Caucasian, and 38% had diabetes. Patients with a clinically meaningful health status improvement (≥8 points) 1 year after their index procedure (79%) were identified as responders. Responders had a significantly better 10 year survival compared with nonresponders (60% vs 38%, p = 0.025). Responder status was associated with a survival advantage that persisted in risk‐adjusted analysis (adjusted hazard ratio for long‐term mortality, 0.66 [95% CI, 0.45–0.97]; p = 0.036). Conclusions Among patients with symptomatic PAD undergoing EVT, improvement of PAD‐specific health status at 1 year follow‐up was associated with improved long‐term survival. Whether additional treatment for patients with poor response to EVT could improve long‐term survival warrants further investigation. © 2016 Wiley Periodicals, Inc.