This study assessed whether time serves as a previously undefined predictor of both limb and patient survival in individuals with acute limb ischemia (ALI) and critical limb ischemia (CLI). Patients with ALI or CLI referred to a single metropolitan tertiary care hospital were consecutively entered into the prospective “FReedom from Ischemic Events: New Dimensions for Survival” (FRIENDS) registry. Demographics, key time segments and short-term outcomes were evaluated for all patients. Key time segments were reported as median and interquartile range (IQR). Myocardial infarction (MI), stroke, amputation and all-cause mortality were collected at one month. From 2/07 through 12/09, 206 patients (75 ALI, 131 CLI) were enrolled in the FRIENDS registry. The median age was 76 (64, 84) years and 58% were male patients. Median time from symptom onset to admission was 19.2 hours (7.2, 79.2) for ALI and 59 days (24, 124) for CLI patients. Length of stay was 7.0 days (4.3, 10.4) for ALI and 6.1 days (3.1, 10.7) for CLI patients. Minor and major amputation was performed during the index hospitalization in 10 (13%) of patients with ALI and 34 (26%) of those with CLI. In ALI patients, amputation was significantly associated with increased duration of ischemia (P=0.015 for trend), but this trend was not observed in CLI patients. One month after discharge, a longer duration of ischemia was significantly associated with an increase in the quadruple endpoint of nonfatal MI, stroke, amputation or death in patients with ALI (P=0.007 for trend). No such association was observed in individuals with CLI. Amputation-free survival at one month was 78.7% and 71.8% for patients with ALI and CLI, respectively. In conclusion, these data suggest that expedited admission and treatment for ALI is associated with lower rates of in-hospital amputation and morbidity and mortality at one month. There was no association between the duration of ischemia and morbidity and mortality among the CLI patients. These data clarify a high incidence of ALI amongst patients with severe PAD; verify that length of stay remains long and major adverse outcomes remain common even within the first month of a severe PAD admission. Future research might investigate the biological mechanisms and processes of care that could link the long referral times and high rates of vascular ischemic events.
University of Minnesota M.S. thesis. June 2010. Major: Clinical Research. Advisor: Alan T. Hirsch. 1 computer file (PDF); x, 68 pages. Ill. (some col.); appendices 1-6.
Keo, Hak Hong.
Severe peripheral artery disease: new observations from a community-based Minnesota Registry..
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