1. Evolution of Major Amputation Risk in Patients Hospitalized in France for Critical Limb Ischemia: The COPART Registry
- Author
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Alessandra Bura-Rivière, Emmanuel Messas, Victor Aboyans, François-Xavier Lapébie, Ileana Desormais, Marion Mangin, Carine Boulon, P. Lacroix, Alice Coudene, Joël Constans, Valerie Aurillac, Service des Maladies Cardiaques et Vasculaires [CHU Bordeaux], CHU Bordeaux [Bordeaux], Service de Médecine Vasculaire [CHU Toulouse], Centre Hospitalier Régional Universitaire de Toulouse (CHRU Toulouse), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Département d'endocrinologie - Bordeaux 2, Université Bordeaux Segalen - Bordeaux 2, Service de cardiologie [CHU Limoges], Service d'hypertension artérielle et médecine vasculaire, Hôpital Européen Georges Pompidou [APHP] (HEGP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)
- Subjects
Male ,critical limb ischemia ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Statin ,medicine.drug_class ,Critical Illness ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,peripheral artery disease ,Revascularization ,Risk Assessment ,Amputation, Surgical ,Peripheral Arterial Disease ,03 medical and health sciences ,Cohorte des Patients ARTeriopathes ,0302 clinical medicine ,Ischemia ,Risk Factors ,Internal medicine ,Angioplasty ,medicine ,Humans ,Registries ,030212 general & internal medicine ,major amputation ,Aged ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Critical limb ischemia ,Odds ratio ,Middle Aged ,Limb Salvage ,3. Good health ,Hospitalization ,Treatment Outcome ,Cohort ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,France ,prognosis ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
International audience; Over the past decade, improvements in medical treatment and revascularization techniques have been beneficial for patients with peripheral artery disease in the late stage of critical limb ischemia (CLI). We evaluated the putative reduction in the number of major amputees in the Cohorte des Patients ARTeriopathes (COPART) cohort over time. Patients were selected from this multicenter cohort, from 2006 to 2016, for CLI according to Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease II criteria. Patients included before and after 2011 were compared. Patients were followed for 1 year. Primary outcome was the rate of major amputations. Secondary outcomes were minor amputations, deaths from all causes, cardiovascular deaths; 989 patients were included, 489 before 2011 and 450 after 2011. There was a significant decrease in rates of major amputation after 2011 (17% vs 25%), confirmed in multivariate analysis (odds ratio [OR]: 1.5 [1.1-2.2]), an increase in revascularization, particularly distal angioplasty (OR: 2.7 [1.7-4.4]) and increased statin intake (OR: 1.6 [1.1-2.1]). For secondary outcomes, there was no significant difference. Limb prognosis of CLI patients has improved over the past decade, possibly due to more revascularizations, particularly distal ones, and increased statin use.
- Published
- 2020