Authors
- Mislav Vrsalović — University of Zagreb School of Medicine, Zagreb, Croatia — ORCID: 0000-0002-8432-404X
- Tonći Batinić — University Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia — ORCID: 0000-0002-8431-6963
- Nikola Kos — University Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia — ORCID: 0000-0001-8829-2543
- Ksenija Vučur — University Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0002-8255-4933
- Boris Car — University Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia — ORCID: 0000-0002-1859-3102
Keywords
peripheral artery disease, chronic limb threatening ischemia, major adverse cardiovascular events, polyvascular disease
DOI
https://doi.org/10.15836/ccar2021.75Full Text
Aim : Patients with peripheral artery disease (PAD) are at very high risk of cardiovascular events. ( 1 - 3 ) The first Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD) was created in 2010, with the aim to collect, organize and present data about patients with PAD. The purpose was to evaluate risk factors, prognosticators, longitudinal outcomes, and therapeutic development in order to improve patients’ healthcare and disease outcomes. Patients and Methods : The occurrence of major adverse cardiovascular events (MACE), defined as composite endpoint of acute myocardial infarction, stroke, and death was assessed in 1084 symptomatic PAD patients admitted to the University Hospital between January 2010 and January 2020 (65% men, age 70±10 years). Multivariate Cox regression analysis adjusted for age, gender, traditional cardiovascular risk factors, polyvascular disease, chronic limb threatening ischemia (CLTI), atrial fibrillation (AF), anemia, statin treatment, and impaired renal function was applied to assess the independent predictors of MACE. Results : During median follow-up period of 44 months (interquartile range, 23-59 months), 370 patients (34%) experienced MACE. Compared to patients without MACE, these patients were older, more likely to have diabetes, hypertension, CLTI, polyvascular disease, AF, anemia, and renal impairment. In multivariate regression analysis, age (HR 1.03, 95% CI 1.02-1.04), polyvascular disease (HR 1.42, 95% CI 1.15-1.77), CLTI (HR 1.91, 95% CI 1.54-2.36), AF (HR 1.54, 95% CI 1.18-2.01) and anemia (HR 1.65, 95% CI 1.31-2.06) remained independent predictors of MACE. Patients with both polyvascular involvement and CLTI were four times more likely to experience MACE compared to those with PAD alone ( Figure 1 ). Cumulative major adverse cardiovascular events (MACE) free survival in 1084 symptomatic PAD patients according to polyvascular involvement (POLYVASC) and chronic limb threatening ischemia (CLTI). Conclusion : Polyvascular involvement, critical limb ischemia, anemia, and AF were independent predictors of MACE in symptomatic PAD patients during long-term follow-up.