bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geriatric nutritional risk index (GNRI) predicts long-term survival and limb events in patients with peripheral artery disease
Authors: Horiguchi M , Yamagishi H , Unno K , Takamura T , Tone K , Sakabe S , Maeno K , Izumi D , Seko T , Kasai A 
Published: November 2020

Abstract

Background
Geriatric nutritional risk index (GNRI) was developed as a “nutrition-related” risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality.

Purpose
The purpose of this study was to assess the associations of GNRI with mortality and amputation free survival in patients with peripheral artery disease (PAD).

Methods
From January 2011 to June 2016, 295 consecutive patients (73.3±9.2 years; 75.6% male) with PAD undergoing endovascular treatment (EVT) in our hospital were retrospectively examined. The GNRI on admission was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × body mass index (BMI)/22. Characteristics and mortality were compared between 2 groups: low GNRI (&lt;92, n=110) with moderate or severe nutritional risk; and high GNRI (≥92, n=185) with no or low nutritional risk.

Results
The median follow up period was 39.4±26.4months. There were 85 deaths (28.8%) and 13 major amputation (4.4%) during the follow-up. Patients in the low-GNRI group were more often higher age, non-ambulatory state, hemodialysis and critical limb ischemia. BMI, serum hemoglobin, albumin, low-density lipoprotein were significantly lower, whereas serum C-reactive protein was significantly higher in the low-GNRI group than the high-GNRI group (P&lt;0.05, respectively). Kaplan–Meier analysis revealed that patients in the low-GNRI group had a significantly lower amputation free survival, compared to those in the high-GNRI group (log-rank test, P&lt;0.001).

Conclusion
The low GNRI is associated with an increased risk of mortality and limb events in patients with PAD.
Amputation-free survival (Kaplan-Meier)

Funding Acknowledgement
Type of funding source: None
Prevalence, clinical characteristics and prognosis of intracranial artery atherosclerosis in heterozygous familial hypercholesterolemia: insights from magnetic resonance angiography imaging analysis
Authors: Funabashi S , Kataoka Y , Hori M , Ogura M , Matsuki K , Doi T , Noguchi T , Harada-Shiba M 
Published: November 2020

Abstract

Introduction
Heterozygous familial hypercholesterolemia (HeFH) exhibits substantially atherogenic substrate which involves coronary and peripheral arteries. Whether atherosclerosis in HeFH propagates to intracranial arteries causing stroke remains to be determined.

Purpose
To characterize intracranial artery stenosis (IAS) in subjects with HeFH.

Methods
148 HeFH subjects who underwent MRI/MRA imaging to evaluate intracranial arteries were analyzed. IAS was defined as the presence of stenosis with its % diameter stenosis ≥25%. Clinical demographics and cardiovascular events (all-cause death, ACS, stroke and PAD) were compared in those with and without IAS.

Results
IAS was observed in 24.3% (=36/148) of study subjects. It was more frequently located at middle cerebral artery (30.6%=11/36), followed by internal carotid artery (25.0%=9/36). 47.2% of IAS exhibited % diameter stenosis ≥75%. Furthermore, 58.3% of HeFH patients with IAS exhibited concomitance of CAD, PAD or carotid stenosis. They were more likely to be older (Table). While there was no significant difference in LDL-C level, an elevated triglyceride level was observed in those with IAS (Table). Of note, during the observational period (median=14.1 years), IAS was associated with a greater likelihood of experiencing not only stroke but other cardiovascular events (all-cause death + ACS + PAD) (picture). Multivariate analysis demonstrated triglyceride level ≥1.7mmol/l as an independent predictor of IAS in HeFH patients (HR=5.53, 95% CI: 1.85–16.5, p=0.002).

Conclusions
Around one-fourth of HeFH patients harboured IAS, which was associated with concomitance of atherosclerosis in other vascular beds and the occurrence of stroke and other cardiovascular events. Given the relationship of IAS with hypertriglyceridemia, this lipid feature may be an important contributor to atherosclerotic formation which involves intracranial artery in HeFH patients.
Clinical outcome

Funding Acknowledgement
Type of funding source: None
Atrial fibrillation in a cohort of patients with peripheral arterial disease. A retrospective study of a healthcare database in UK
Authors: Vitalis A.V , Shantsila A.S , Thayakaran R.T , Nirantharakumar K.N , Lip G.Y.L 
Published: November 2020

Abstract

Atrial fibrillation in a cohort of patients with peripheral arterial disease. A retrospective study of a healthcare database in UK.

Background
There is strong evidence that peripheral arterial disease (PAD) is linked with worse outcomes in patients with atrial fibrillation (AF), which has led vascular disease to be included as one of the components of CHA2DS2-VASc score for risk stratification in AF. On the other hand, very limited evidence exists on the prognostic implication of AF in patients with PAD.

Purpose
The aim of this study is to identify the prevalence of AF in a cohort of PAD patients and demonstrate its association with adverse cardiovascular outcomes, limb loss and mortality.

Methods
This is a retrospective study of The Health Improvement Network (THIN) database, which contains computerized records from primary care physicians, covering more than 11 million patients from over 600 general practices in the UK. During the studied period from 1995 to 2017, 55540 patients with newly diagnosed PAD have been detected in the database and baseline characteristics, coexisting medical diagnoses (including AF), relevant medication and subsequent outcomes have been recorded using appropriately selected clinical codes (READ codes). A comparison of baseline characteristics was made between patients with PAD and AF and those without AF using descriptive statistics. Multivariate cox regression analysis was then performed and hazard rations for mortality, stroke or transient ischaemic attack (TIA), ischaemic heart disease (IHD), heart failure (HF) and major lower limb amputation at presence of AF were calculated, after adjustment for age, sex, ethnicity, BMI, smoking, Townsend comorbidity index, diabetes, hypertension, kidney function, and medication (lipid- lowering, antiplatelets, anticoagulants).

Results
From the 55540 patients with new diagnosis of PAD during the study period, 5685 (10.2%) had coexisting AF. Patients with AF were older, had higher prevalence of diabetes, hypertension and renal failure, were more likely to be on anticoagulants, antiplatelets and lipid lowering agents, were more likely to be ex-smokers but less likely to be active smokers. Mean follow up period was 5.1 (SD= 4) years. After adjustment for confounders, AF patients were at higher risk for death (HR: 1.30, 95% CI 1.24- 1.37, p&lt;0.01) for stroke or TIA (HR: 1.46, 95% CI 1.29- 1.65, p&lt;0.01) and for HF (HR: 1.85, 95% CI 1.65- 2.08, p&lt;0.01). There was no significant association between AF and development of IHD (p=0.34) and limb loss (p=0.14) in this cohort.

Conclusion
AF is a predictor of worse prognosis in patients with PAD. Close monitoring and medical optimization of these patients is warranted.

Funding Acknowledgement
Type of funding source: None
PAD patients present with poorer lipid target attainment than polyvascular patients – a call for intensified treatment
Authors: Dopheide J.F , Adam L , Khorrami Borozadi M , Kaspar M , Baumgartner I , Drexel H 
Published: November 2020

Abstract

Background
Due to the very high risk of future cardiovascular events, strict lipid lowering therapy is recommended in patients with peripheral artery disease (PAD). However, data on target level attainment and statin adherence is scarce, especially when the atherosclerotic burden is extended to other vascular beds, i.e. coronary artery disease (CAD) and/ or cerebrovascular disease (CeVD).

Purpose
We hypothesized that patients with PAD alone have poorer lipid target attainment than polyvascular patients (+ CAD and/ or CeVD) and that an intensified statin therapy improves attainment of lipid targets and thus survival of patients with PAD only.

Methods
Single center longitudinal observational study with 1380 symptomatic PAD patients over a mean follow-up period of 60±32 months. We related statin adherence and LDL-C target attainment to all-cause mortality.

Results
Initially, 58% of the PAD only patients were on statins in contrast to PAD patients with one (+1V (79%)) or two (+2V (80%)) further vascular regions. At follow up we observed an increase to 87% statin use (p&lt;0.0001) in PAD only patients. Statin use in +1V and +2V patients increased as well (+1V: 92%; +2V: 87%). Lipid target attainment in PAD only (&lt;55 mg/dl) was observed in only 10%, but increased to 19%. Statin dosage in PAD only patients, normalized to simvastatin 40 mg, increased from 46 to 52 mg/ day (p&lt;0.01), and was paralleled by a mean decrease of LDL-C from 103 to 84 mg/ dL (p&lt;0.0001).
PAD only patients had a significant lower mortality rate (13%) than +1V (22%) or +2V patients (35%) (p&lt;0.0001). Survival of PAD only patients significantly improved when having newly received a statin (11%), similar to those continuously on statins (10%). Moreover, patients on a high intensity statin medication had a low mortality of 10%. Those who terminated statin medication or never received a statin had a higher mortality (26%; p&lt;0.01).

Conclusion
Patients with a PAD only have a lower mortality than PAD patients where progression to one or two vascular beds occurred. Our data suggest that for PAD only patients an intensified statin therapy is then associated with reduced mortality. A strategy of intensive and sustained statin therapy as early as possible is recommended.
PAD only Statin Therapy outcomes

Funding Acknowledgement
Type of funding source: None
TRIACCESS study: randomized comparison between radial, femoral and transpedal access for for percutanous supertfitial femoral artery angioplasty
Authors: Ruzsa Z , Csavajda A , Deak M , Sotonyi P , Bertrand O.F , Kwan T.W , Nemes B , Becker D , Hizoh I , Merkely B 
Published: November 2020

Abstract

Background
Traditional access for the treatment of femoral artery lesions is the femoral artery (FA) approach, but radial (RA) and pedal access (PA) is an alternative access site. The aim of the study was to compare the success rate, complication rate of different access sites for the treatment of superfitial artery stenosis in a randomized study

Methods
180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral stenosis, via RA, FA and PA. Primary endpoint: technical success, rate of major and minor access site complications. Secondary endpoints: major adverse events (MAE), procedural factors, cross-over rate, and duration of hospitalization.

Results
Technical success was achieved in 96.6%, 100% and 100% patients in RA, FA and PA group (p=ns). Secondary access site was used in 30%, 3.3% and 30% in the RA, FA and PA access group (p&lt;0.01). Stent implantation was done in the femoral artery in 26.6%, 58.3% and 71.6% cases in RA, FA and PA group (p&lt;0.01). CTO recanalization was performed in 34/36 (100%), 30/30 (100%) and 45/45 (100%) cases successfully in RA, FA and PA group (p=ns). Contrast consumption, fluoroscopy and procedure time was not statistically different, but the X Ray dose was significantly lower in PA than in the RA and FA access group (63.1 vs 162 vs 153 Dyn). The cumulative rate of access site complications in the RA, FA and PA group was 3.3% (0% major and 3.3% minor), 15% (3.3% major and 11.6% minor) and 3.3% (0% major and 3.3% minor) (p&lt;0.01), respectively. The cumulative incidence of MAE's at 6 months in the RA, FA and PA group was 8.3% vs 13.3% and 18.3%. (p&lt;0.05)

Conclusion
Femoral artery intervention can be safely and effectively performed using radial, femoral and pedal access, but radial and pedal access is associated with less access site complication rate. Pedal access is associated with less X Ray dose than radial and femoral access.

Funding Acknowledgement
Type of funding source: None
Applicability of the VOYAGER trial criteria: a cohort study on patients in the nationwide Danish Vascular Registry
Authors: Soegaard M , Nielsen P.B , Skjoeth F , Larsen T.B , Eldrup N 
Published: November 2020

Abstract

Introduction
Peripheral artery disease (PAD) carries a high risk of debilitating stroke, myocardial infarction, and death. The VOYAGER PAD trial investigates whether rivaroxaban 2.5 mg plus aspirin vs aspirin alone leads to a reduction in major adverse cardiovascular events (MACE) in patients with symptomatic PAD undergoing revascularization. However, it is unclear whether patients enrolled in VOYAGER PAD reflect those undergoing lower extremity revascularization in daily clinical practice.

Purpose
To describe the proportion of patients eligible for the VOYAGER PAD trial within the nationwide Danish Vascular Registry (DVR), the reasons for ineligibility, and rates of cardiovascular outcomes in VOYAGER-eligible and VOYAGER-ineligible patients.

Methods
We identified and characterized all patients from 2000–2016 undergoing open surgical or endovascular revascularization for symptomatic PAD in the DVR and applied the VOYAGER inclusion and exclusion criteria. We computed one-year rates per 100 person-years of VOYAGER PAD trial endpoints of MACE, myocardial infarction, ischemic stroke, major amputation, major bleeding, cardiovascular (CV) death, and all cause death.

Results
In the DVR, 32,911 patients underwent lower extremity revascularization for symptomatic PAD and were evaluated for eligibility. Among these, 32.2% had at least one exclusion criteria and an additional 40.6% without exclusion criteria did not fulfil inclusion criteria. The “VOYAGER-eligible” population therefore comprised 27.2% of the identified patients (Figure 1A). Main reasons for exclusion were atrial fibrillation (30.7%), poorly regulated hypertension (19.6%), PCI or ACS within 12 months before (16.0%), treatment with strong inhibitors or inducers of cytochrome P450 (9.2%), active cancer (8.8%), and severe renal failure (8.3%). Main reasons for non-inclusion were aorto-iliac procedures (79.0%), non-successful revascularization (13.1%), and age&lt;50 years (7.1%). Compared with “VOYAGER-eligible” patients, event rates were slightly lower among patients in the DVR not fulfilling inclusion criteria and markedly higher for “VOYAGER excluded” patients (Figure 1B).

Conclusion
In this nationwide cohort of symptomatic PAD patients undergoing lower extremity revascularization, 27.2% full filled the inclusion and exclusion criteria for dual pathway therapy in the VOYAGER PAD trial. Non-inclusion predominantly related to aorto-iliac procedures and were associated with lower event rates. Future studies are needed to clarify if these patients could also benefit from dual pathway therapy.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer AG, Berlin, Germany
Lymphocyte-to-monocyte ratio is an independent predictor of 90-day mortality after endovascular therapy in the patients with critical limb ischemia
Authors: Ukita K 
Published: November 2020

Abstract

Background
Critical limb ischemia (CLI), the most severe form of peripheral artery disease (PAD), is associated with a high risk of mortality. We usually perform endovascular therapy (EVT) for CLI, but not a few patients with CLI die in the early period after EVT. There is some research on the relationship between inflammatory responses and mortality after EVT for CLI, but little has been reported on the association of mortality after EVT and lymphocyte-to-monocyte ratio (LMR), which has recently been considered to be a novel inflammatory marker.

Purpose
The purpose of this study was to investigate the relationship between LMR and 90-day mortality after EVT in the patients with CLI.

Methods
We enrolled the consecutive patients with CLI undergoing EVT between September 2014 and September 2019 in our hospital. We compared pretreatment LMR between D group who died within 90 days after EVT and S group who survived more than 90 days.

Results
A total of 281 patients were enrolled in this study. D group consisted of 33 patients and S group consisted of 248 patients. The univariate analysis showed that pretreatment LMR was significantly lower in D group compared with S group (4.04±1.56 vs 4.86±1.45, P=0.002), and this result remained significant in the multivariate analysis (hazard ratio [HR]: 0.415, 95% confidence interval [CI]: 0.214–0.789; P=0.013).

Conclusions
LMR is an independent predictive factor of 90-day mortality after EVT in the patients with CLI.

Funding Acknowledgement
Type of funding source: None
Extremely elevated lipoprotein (a) as an independent risk factor for peripheral arterial disease in large patient cohort
Authors: Poudel M.R , Kirana S , Stoyanova D , Mellwig K.P , Hinse D , Knabbe C , Sauzet O , Gottfried R , Rudolph V , Rudolph T.K , Van Buuren F 
Published: November 2020

Abstract

Background
Elevated lipoprotein (a) [LP (a)] levels are an independent, genetic, and causal factor for cardiovascular disease and associated with myocardial infarction (MI). Although the association between circulating levels of lipoprotein(a) [Lp(a)] and risk of coronary artery disease (CAD) is well established, its role in risk of peripheral arterial disease (PAD) remains unclear. PAD affects over 236 million individuals and follows ischaemic heart disease (IHD) and cerebrovascular disease (CVD) as the third leading cause of atherosclerotic cardiovascular morbidity worldwide. LP (a) is genetically determined, stable throughout life and yet refractory to drug therapy. While 30 mg/dl is considered the upper normal value for LP (a) in central Europe, extremely high LP (a) levels (&gt;150mg/dl) are rare in the general population.
The aim of our study was to analyse the correlation between lipoprotein (a) [LP (a)] levels and an incidence of PAD in high-risk patients.

Patients and methods
We reviewed the LP (a) concentrations of 52.898 consecutive patients admitted to our cardiovascular center between January 2004 and December 2014. Of these, 579 patients had LP (a) levels above 150 mg/dl (mean 181.45±33.1mg/dl). In the control collective LP (a) was &lt;30mg/dl (n=350). Other atherogenic risk factors in this group were HbA1c 6.58±1.65%, low density lipoprotein (LDL) 141.99±43.76 mg/dl, and body mass index 27.81±5.61. 54.40% were male, 26.07% were smokers, 93.2% had hypertension, and 24% had a family history of cardiovascular diseases. More than 82.6% were under statins. The mean glomerular filtration rate (GFR) was 69.13±24.8 ml/min [MDRD (Modification of Diet in Renal Disease)].

Results
45.00% (n=261) of the patients with LP (a) &gt;150mg/dl had PAD. The prevalence of PAD in patients with LP (a) &lt;30mg/dl in our control collective was 15.8%. (P- Value 0.001). Patients with LP (a) &gt;150mg/dl had a significantly increased risk for PAD (Odds ratio 4.36, 95% CI 2.94–6.72, p: 0.001).
19.1% of patients were re-vascularized by percutaneous angioplasty (PTA) and 7.09% of patients had to undergo peripheral vascular bypass (PVB). Mean LP (a) level in patients with PAD was 182.6±31.61.

Conclusion
Elevated LP (a) levels above 150 mg/dl are associated with a significantly increased risk of PAD in our collective and it confirms our hypothesis. Over one fourth of these patients had severe PAD and requiring revascularization therapy. We need more prospective studies to confirm our findings.

Funding Acknowledgement
Type of funding source: None
Statins bring the prognostic impact only in peripheral artery disease patients with elevated c-reactive proteins -subanalysis from multicenter registry-
Authors: Shibahashi E , Jujo K , Ueshima D , Fujimoto Y , Shimazaki K , Tanaka T , Murata T , Miyazaki T , Matsumoto M , Tokuyama H , Shimura T , Higashitani M 
Published: November 2020

Abstract

Introduction
Recent trials demonstrated favorable effects of statins on the clinical prognosis, partly through anti-inflammatory properties, in patients with coronary artery disease. However, this favorable effect has not been fully verified in patients with peripheral arterial disease (PAD). We hypothesized that statins exert different prognostic effects depending on the degrees of inflammation at the time of endovascular therapy (EVT).

Methods
This study is a subanalysis from the Toma-Code Registry that is a Japanese prospective cohort of 2,321 consecutive patients with PAD treated by endovascular therapy in hospitals from 2014 to 2016. After the exclusion of patients without information of C-reactive protein (CRP) at the time of index EVT, 2,039 patients including 1,039 statin users and 1,000 statin non-users were ultimately analyzed. The patient enrolled were divided into 4 categories depending on CRP level at the time of EVT; Low-CRP (&lt;0.1 mg/dL), Intermediate-low-CRP (0.1–0.3 mg/dL), Intermediate-High-CRP (0.3–1.0 mg/dL), and High-CRP (&gt;1.0 mg/dL). A composite of death, stroke, myocardial infarction, and major amputation as the primary endpoint of this study was compared between statin users and non-users in each CRP category.

Results
The composite endpoint occurred in 255 patients during the observation period. Overall, statin users had a significantly lower event rate than non-users (Log-rank test: P&lt;0.001). However, there were no significant difference in the event rates between statin users and non-users in the Low-, and Intermediate-Low-CRP categories. Only in the Intermediate-High- and the High-CRP categories, statin users showed a significantly lower event rates than non-users (P=0.02 and P=0.008, respectively, Figures). Additionally, multivariate Cox regression analysis in the High-CRP group revealed that statin use was independently associated with the primary endpoint (adjusted hazard ratio: 0.67 [95% confidence interval: 0.45–0.99]), even after the adjustment of covariants.

Conclusion
Statins may exert a favorable prognostic effect in PAD patients with highly elevated CRP, but not in those with low to moderate CRP level.
Event free survival

Funding Acknowledgement
Type of funding source: None