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This study aimed to apply eight machine learning algorithms to develop the optimal model to predict amputation-free survival (AFS) after first revascularization in patients with peripheral artery disease (PAD). Among 2130 patients from 2011 to 2020, 1260 patients who underwent revascularization were randomly assigned to training set and validation set in an 8:2 ratio. 67 clinical parameters were analyzed by lasso regression analysis. Logistic regression, gradient boosting machine, random forest, decision tree, eXtreme gradient boosting, neural network, Cox regression, and random survival forest (RSF) were applied to develop prediction models. The optimal model was compared with GermanVasc score in testing set comprising patients from 2010. The postoperative 1/3/5-year AFS were 90%, 79.4%, and 74.1%. Age (HR:1.035, 95%CI: 1.015–1.056), atrial fibrillation (HR:2.257, 95%CI: 1.193–4.271), cardiac ejection fraction (HR:0.064, 95%CI: 0.009–0.413), Rutherford grade ≥ 5 (HR:1.899, 95%CI: 1.296–2.782), creatinine (HR:1.03, 95%CI: 1.02–1.04), surgery duration (HR:1.03, 95%CI: 1.01–1.05), and fibrinogen (HR:1.292, 95%CI: 1.098–1.521) were independent risk factors. The optimal model was developed by RSF algorithm, with 1/3/5-year AUCs in training set of 0.866 (95% CI:0.819–0.912), 0.854 (95% CI:0.811–0.896), 0.844 (95% CI:0.793–0.894), in validation set of 0.741 (95% CI:0.580–0.902), 0.768 (95% CI:0.654–0.882), 0.836 (95% CI:0.719–0.953), and in testing set of 0.821 (95%CI: 0.711–0.931), 0.802 (95%CI: 0.684–0.919), 0.798 (95%CI: 0.657–0.939). The c-index of the model outperformed GermanVasc Score (0.788 vs 0.730). A dynamic nomogram was published on shinyapp (https://wyy2023.shinyapps.io/amputation/). The optimal prediction model for AFS after first revascularization in patients with PAD was developed by RSF algorithm, which exhibited outstanding prediction performance. • Risk factors for amputation-free survival (AFS) of peripheral artery disease were identified by lasso regression analysis. • Among 8 machine learning algorithms, the optimal prediction model for AFS was developed by random survival forest algorithm. • New machine learning algorithm can build prediction models with excellent capability than conventional LR and Cox models. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is a cardiovascular disease that limits patients' walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. The purpose of the study was to determine the implementation and patients' perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. A convergent mixed methods design was used to evaluate participants' perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. Vascular surgery clinic and biomechanics research laboratory. Patients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. A certified orthotist fit participants with an AFO that was worn for 3 months. Qualitative analysis of semi-structured interviews and quantitative analysis of the survey. The highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. Barriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients' perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject's lifestyle. Clinical Trial Registration No.: NCT02902211. • Chronic peripheral artery disease causes muscle weakness that impairs walking. • An ankle-foot orthosis may improve the distance patients with peripheral artery disease can walk. • 6 months post-intervention questionnaire assessments were based on i-PARIHS framework. [ABSTRACT FROM AUTHOR]

The innovative pharmacological combination of low-dose rivaroxaban plus aspirin provides clinicians with an ideal opportunity to intensify the medical treatment of patients with coronary artery disease (CAD) and comorbid peripheral artery disease (PAD). We aimed to determine the cost-effectiveness of PAD screening using the ankle-brachial index (ABI) test in patients with CAD (with rivaroxaban administered if the PAD screening was positive) compared with no-screening strategy in China. A Markov decision model using a 1-month cycle was developed to simulate the 25-year effectiveness and cost of PAD screening on 75-year-old patients with CAD in China, evaluating the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the impact of variations in the key parameters for ICERs. Our model found an incremental cost of RMB4,959 (US$740) and an incremental QALY of 0.054 after one-time ABI screening, leading to an ICER of RMB91,936 (US$13,717) per QALY gained over a 25-year period. The reduction in all-cause mortality related to rivaroxaban and its cost were the factors most affecting the ICER. The screening would become cost-effective by decreasing the monthly cost of rivaroxaban to RMB184.5 (US$27.5) or by using domestic-brand rivaroxaban according to the threshold of a willingness to pay RMB72,447 (US$10,809) per QALY gained. Our study demonstrated that ABI screening for PAD to decide on low-dose rivaroxaban administration was not cost-effective for patients with CAD in China. Nevertheless, policy-guided cost changes for domestic-brand rivaroxaban could easily resolve this issue. • ABI screening for PAD was not cost-effective for patients with CAD in China. • The reduction in all-cause mortality related to rivaroxaban most affected the ICER. • Policy-guided cost changes for rivaroxaban could easily resolve this issue in China. [ABSTRACT FROM AUTHOR]

In recent randomized controlled studies, the prevention of stroke and cognitive function of ticagrelor has been controversial. We conducted a meta-analysis to compare ticagrelor with other antiplatelet treatment in patients with vascular high-risk factors disease, defined as acute coronary syndrome, stroke or transient ischemic attack, coronary artery disease or peripheral artery disease. We searched the PubMed, Embase, and Cochrane libraries for published randomized controlled trials and additional available data from ClinicalTrials.gov. The primary outcome was related adverse stroke events and the secondary outcome was cognitive function related adverse events. The outcomes were statistically analyzed using Peto odds ratio. 12 RCTs with 105,654 patients were included in meta-analysis. Primary outcomes: all stroke (OR 0.84, 95%CI 0.78–0.90, P < 0.001); Secondary outcomes: ischemic stroke (OR 0.83, 95%CI 0.77–0.90, P < 0.001), transient ischemic attack (OR 0.78, 95%CI 0.62–0.97, P = 0.029), intracranial hemorrhage (OR 1.33, 95%CI 1.09–1.61, P = 0.005), Parkinson's disease (OR 0.30, 95%CI 0.12–0.72, P = 0.007), dementia (OR 0.31, 95%CI 0.13–0.77, P = 0.012), dizziness (OR: 1.39, 95%CI 1.03–1.87, P = 0.032), insomnia (OR 1.45, 95%CI 1.05–2.00, P = 0.026). Ticagrelor may provide more favorable outcomes for all stroke, ischemic stroke, and transient ischemic attack prevention in patients with vascular high-risk factors. However, this benefit may come with the cost of intracranial hemorrhage, dizziness and insomnia. Ticagrelor may reduce the risk of dementia and Parkinson's disease, although available data are limited. • Ticagrelor reduces the risk of all-cause stroke, ischemic stroke and TIA in patients with vascular high-risk factors; • Ticagrelor may reduce the risk of dementia and Parkinson's disease in patients with vascular high-risk factors； • Ticagrelor is a highly potent platelet drug that does not increase the risk of death; • Ticagrelor still needs to be further studied on its effect on cognitive function. [ABSTRACT FROM AUTHOR]

Paclitaxel-eluting devices (PED) reduce restenosis and target lesion revascularization (TLR) in femoropopliteal intervention. Recent data suggest a two-fold increased long-term mortality in patients treated with PED. The aim of our study is to evaluate if endovascular therapy (EVT) with PED increases mortality risk in patients with symptomatic lower limb peripheral artery disease (PAD) compared to non-eluting devices (NED). The study is a retrospective, single-center registry on patients undergoing EVT for PAD from January 2009 to June 2018. Propensity score analysis on logistic regression model for independent predictors of long-term mortality was used to match PED and NED patients. Mortality was assessed at 2, 5 and 7 years in the entired matched population and in a sub-group of patients ≤75 years. During the study period, 1294 patients, 718 NED and 576 PED, met the inclusion/exclusion criteria and entered in the study. Propensity score matching analysis identified 854 matched patients, 414 PED and 440 NED. The population was mainly characterized by diabetic patients with CLI (80%) and high prevalence of CAD (30%), heart failure (15%) and renal insufficiency (20%). Mean follow-up length was 58 ± 34 months, (median 52.5). Mortality was 18% in NED vs 12% in PED patients at two years (p = 0.01), 36% vs 30% at 5 years (p = 0.03) and 41% vs 39% at seven years (p = 0.2) respectively. In patients ≤75 years, mortality at 7-year was 28% in PED vs 36% in NED, p = 0.07. These results suggest a reduced mortality at 2 and 5 years with PED as compare to NED treatment in a real-world CLI scenario. At 7-year follow-up, the advantage was numerically evident only in patients ≤75 years. • Angioplasty of lower limb arteries is associated with a high incidence of restenosis. • Paclitaxel-eluting devices reduce restenosis and target lesion revascularization in lower limb ischemia. • Recent data are conflicting about long-term mortality in patients treated with PED. • In real world scenario paclitaxel-eluting devices reduce major limb adverse events and mortality at 2 and 5 years follow-up. [ABSTRACT FROM AUTHOR]

Background The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that rivaroxaban plus aspirin reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD). We explored whether CHA 2 DS 2 -VASc or CHADS 2 scores, well-validated tools for assessing risk of thromboembolic events in atrial fibrillation, can identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment. Methods Predictive accuracies of the CHA 2 DS 2 -VASc and CHADS 2 scores for MACE, were assessed in this analysis of the COMPASS trial. Kaplan-Meier estimates of cumulative risk were used to compare the effects of rivaroxaban plus aspirin (n = 9152) with aspirin alone (n = 9126) according to risk scores. Results High CHA 2 DS 2 -VASc (6–9) or CHADS 2 (3–6) scores were associated with over three times greater absolute risk of MACE compared with CHA 2 DS 2 -VASc score of 1–2 or CHADS 2 score of 0. The effects of rivaroxaban plus aspirin compared with aspirin alone were consistent across CHA 2 DS 2 -VASc and CHADS 2 score categories for MACE, bleeding and net clinical benefit, with greatest reduction in MACE observed in patients treated for 30 months with highest CHADS 2 score (3–6) (hazard ratio = 0.67, 95% CI: 0.53–0.86, p = 0.0012, 25 events per 1000 patients prevented). Conclusion The CHA 2 DS 2 -VASc and CHADS 2 scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE. Those identified at highest risk by CHADS 2 scores had greatest benefit from dual pathway inhibition with rivaroxaban plus aspirin. Clinical Trial Registration: NCT01776424 • High CHA 2 DS 2 -VASc/CHADS 2 scores were associated with higher risk of MACE in ASCVD. • Patients with higher CHADS 2 scores had greater benefit of rivaroxaban and aspirin. • The net clinical benefit of rivaroxaban and aspirin vs aspirin alone progressively increased as the CHA 2 DS 2 -VASc score increased - the higher the CHA 2 DS 2 -VASc score the greater the net clinical benefit. [ABSTRACT FROM AUTHOR]