Campania Registry On Peripheral Artery Disease

Study Overview
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Brief Summary
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The CAmpania REgistry on Peripheral Artery Disease (CARE-PAD) is a single-center observational study which has the purpose to collect clinical, laboratory, instrumental, procedural and follow-up data and to evaluate the outcome of peripheral artery disease (PAD) patients.

Detailed Description
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PAD patients had widespread atherosclerosis and show a worse prognosis than patients with coronary artery disease alone. The CAmpania REgistry on Peripheral Artery Disease (CARE-PAD) is a single center observational study conducted at the Department of Advanced Biomedical Sciences of the Federico II University of Naples which aims to collect clinical, laboratory, instrumental, procedural and follow-up data and to evaluate short, medium and long term outcome of PAD patients. Patients with established diagnosis of peripheral arterial disease according to current international guidelines will be included in the observational study. The overall duration of the study will be 10 years. The presence of PAD will be confirmed based on clinical and instrumental criteria: Intermittent claudication and/or critical limb ischemia with presence of haemodynamically significant stenosis/occlusion of the lower limb arteries detected by ultrasound and/or other imaging methods or with ankle/brachial index (ABI) ≤ 0.90. Carotid stenosis of at least 50% at ultrasound and/or at other imaging methods Abdominal aortic aneurysm (≥3 cm) found at ultrasound and/or other imaging methods. History of peripheral/carotid revascularization or of aortic aneurysm treatment. All patients will be managed according to current guidelines and will receive maximal antiatherosclerotic medical therapy to improve cardiovascular prognosis and, if clinically indicated, could undergo peripheral revascularization procedures to improve symptoms and/or limb prognosis. The choice of the revascularization procedure will be based on careful individual evaluation and will take into account, in accordance with current guidelines, several variables such as clinical characteristics, comorbidities, individual surgical risk and feasibility of the percutaneous peripheral revascularization procedure.

Official Title
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Campania Registry On Peripheral Artery Disease

Conditions
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Peripheral Artery Disease

Intervention / Treatment
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* Diagnostic Test: Vascular ultrasound or other imaging methods according to current guidelines
* Diagnostic Test: Laboratory tests
* Drug: Medical treatment according to current guidelines
* Procedure: Endovascular od surgical peripheral revascularizations


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Confirmed diagnosis of peripheral artery disease as follows (one or more of the following): Intermittent claudication with presence of hemodynamically significant stenosis/occlusion of lower limb arteries or pathological ABI (≤ 0.90); Critical limb ischemia with presence of hemodynamically significant stenosis/occlusion of lower limb arteries or pathological ABI (≤ 0.90); Presence of carotid stenosis of at least 50%; Presence abdominal aortic aneurysm (≥ 3 cm); History of peripheral/carotid revascularization or of aortic aneurysm treatment. Exclusion Criteria: Refusal to sign the informed consent

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Vascular ultrasound or other imaging methods according to current guidelines|Peripheral vascular ultrasound / ankle/brachial index / CT angiography / MR angiography / angiography|
|Diagnostic Test: Laboratory tests|Metabolic profile and platelet reactivity|
|Drug: Medical treatment according to current guidelines|Antithrombotic drugs, lipid-lowering drugs, antihypertensive drugs, and pharmacotherapy to increase walking capacity according to current guidelines|
|Procedure: Endovascular od surgical peripheral revascularizations|Endovascular od surgical peripheral revascularizations according to current guidelines|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Major Adverse Cardiovascular Events (MACE) | Death from cardiovascular causes Non-fatal myocardial infarction Non-fatal stroke Ruptured aortic aneurysm | 10 years | 
| Major Adverse Limb Events (MALE) | Development of critical limb ischemia Peripheral revascularization for development of severe ischemia Any amputation | 10 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Any adverse event other than MACE or MALE | Any-cause death or any adverse cardiovascular event other than MACE or MALE (transient ischemic attack, unstable angina, any coronary, carotid or peripheral revascularization); | 10 years | 
| Bleeding events | Periodic assessment of bleeding events according to the BARC classification | 10 years | 
| Instrumental assessment of functional capacity | Instrumental assessment of maximum walking distance (MWD) (meters) | 10 years | 
| Assessment of quality of life | Quality of life will be periodically assessed by evaluating change in EuroQol (EQ) - 5 Dimensions (5D) - 5 Levels (5L) questionnaire (EQ-5D-5L™) from baseline (range 0-1 with 0 expressing the worst health state and 1 the best) | 10 years | 
| Assessment of functional status | Walking capacity will be periodically assessed by evaluating change in Walking Impairment Questionnaire (WIQ) from baseline; range 0-100%, where 0% represents the lowest possible score (ie, answering unable for all questions in that category) and 100% represents the highest possible score (ie, indicating none with regard to difficulty for all questions in that category) | 10 years | 
| Assessment of frailty in geriatric population | All patients aged 65 and over will be assessed for frailty through the Multidimensional Prognostic Index (MPI), a multidimensional score (range 0-1; 0.00-0.33 mild frailty; 0.34-0.66 moderate frailty; 0.67-1.00 severe frailty). | 10 years | 
| Assessment of functional status in geriatric population | Functional status for all patients aged 65 and over will be further assessed with Short Physical Performance Battery (SPPB) (pathologic if ≤ 8 in males and ≤ 7 in females) and Handgrip strength (pathologic in men for ≤ 29 kg when BMI ≤ 24 kg/m2 or ≤ 30 kg when BMI 24,1-28 kg/m2 or ≤ 32 kg when BMI > 28 kg/m2; pathologic in women for ≤ 17 kg when BMI ≤ 23 kg/m2 or ≤ 17,3 kg when BMI 23,1-26 kg/m2 or ≤ 18 kg when BMI 26,1-29 kg/m2 or ≤ 21 kg when BMI > 29 kg/m2) | 10 years | 
| Assessment of cognitive performance in geriatric population | Cognitive status for all patients aged 65 and over will be assessed with: Mini Mental State Examination (MMSE) (< 24/30 normal; 18-24/30 mild cognitive impairment; 12-18/30 moderate cognitive impairment; <12/30 severe cognitive impairment); Clock Drawing Test (pathologic if ≤ 3/5); Digit span forward (pathologic if ≤ 4/16; borderline if 4-5/16; normal if > 5/16) and backward (pathologic if ≤ 3/16; borderline if 3-4/16; normal if > 4/16); Trail making test A (pathologic if > 78 seconds) and B (pathologic if > 273 seconds); Hospital Anxiety and Depression Scale (HADS) ( 0-7 normal; 8-10 borderline; 11-21 pathologic) | 10 years | 
| Evaluation of lipid profile | Periodic evaluation of lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides in mg/dl) | 10 years | 
| Evaluation of metabolic profile | Periodic evaluation of glucose levels (mg/dl) | 10 years | 
| Atherosclerosis progression | Periodical ultrasound evaluation of the progression of atherosclerosis at different vascular districts [measurement of degree of stenosis (%)] | 10 years | 
| P2Y12 Reaction Unit (PRU) at VerifyNow | Platelet aggregation assessed with VerifyNow ADP test in patients who start dual antiplatelet therapy or dual antithrombotic therapy | 28 days | 
| Area under the curve (AUC) at Multiplate with ADP test | Platelet aggregation assessed with Multiplate ADP test in patients who start dual antiplatelet therapy or dual antithrombotic therapy | 28 days | 
| Inhibition of platelet activity (IPA, %) with LTA-ADP 20 µmol/l | Platelet inhibition assessed with LTA-ADP 20 µmol/l in patients who start dual antiplatelet therapy or dual antithrombotic therapy | 28 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Outcome, Peripheral revascularization