Introduction
Methods
Study population
Study procedures
Initial assessment
Follow-up
Endovascular revascularization
Study outcome measurements
Statistical analyses
Results
Patients and preoperative cardiac biomarkers
All patients (n = 239) | Patients without myocardial injury (n = 178) | Patients with myocardial injury (n = 61) |
p value | |
---|---|---|---|---|
Age (years) (mean ± SD) | 71.5 ± 10.1 | 70.5 ± 10.2 | 74.4 ± 9.4 | 0.007 |
Age > 75 years n (%) | 97 (40.6%) | 62 (34.8%) | 35 (57.3%) | 0.003 |
Male n (%) | 134 (56.1%) | 106 (59.6%) | 28 (45.9%) | 0.07 |
BMI kg/m2 (mean ± SD) | 26.8 ± 4.7 | 26.8 ± 4.6 | 27.1 ± 5.3 | 0.809 |
Past medical history | ||||
Hypertension n (%) | 183 (76.6%) | 133 (74.7%) | 50 (82%) | 0.295 |
Diabetes mellitus n (%) | 138 (57.7%) | 100 (56.2%) | 38 (62.3%) | 0.454 |
Insulin treatment | 108 (45.2%) | 78 (43.8%) | 30 (49.2%) | 0.551 |
CAD n (%) | 115 (48.1%) | 81 (45.5%) | 34 (55.7) | 0.184 |
Myocardial infarction n (%) | 59 (24.7%) | 41 (23.0%) | 18 (29.5%) | 0.308 |
TIA/stroke n (%) | 44 (18.4%) | 32 (18.0%) | 12 (20%) | 0.848 |
Chronic heart failure n (%) | 48 (20.1%) | 28 (15.7%) | 20 (32.8%) | 0.006 |
Dialysis n (%) | 12 (5.0%) | 8 (4.5%) | 4 (6.6%) | 0.508 |
Prior smoker n (%) | 170 (71.1%) | 126 (70.8%) | 44 (72.1%) | 0.872 |
Current smoker n (%) | 30 (12.6%) | 25 (14.0%) | 5 (8.2%) | 0.271 |
Rutherford 4 n (%) | 49 (20.5%) | 40 (22.5%) | 9 (14.8%) | 0.2698 |
Rutherford 5 n (%) | 150 (62.8%) | 112 (62.9%) | 38 (62.3%) | 1 |
Rutherford 6 n (%) | 40 (16.7%) | 26 (14.6%) | 14 (23%) | 0.163 |
Treatment | ||||
ASA | 234 (97.9%) | 174 (97.8%) | 60 (98.4%) | 1 |
Clopidogrel | 227 (95.0%) | 171 (96.1%) | 56 (91.8%) | 0.1895 |
Statin | 208 (87.0%) | 160 (89.9%) | 48 (78.7%) | 0.044 |
B-blocker | 141 (59.0%) | 95 (53.4%) | 46 (75.4%) | 0.003 |
ACE inhibitor | 144 (60.3%) | 104 (58.4%) | 40 (65.6%) | 0.365 |
Heparin | 165 (69.0%) | 118 (66.3%) | 47 (77%) | 0.149 |
Oral diabetes drugs | 55 (23.0%) | 42 (23.6%) | 13 (21.3%) | 0.86 |
Laboratory parameters | ||||
Hb g/dL | 12.4 (10.9–13.5) | 12.6 (11.3–13.6) | 11.4 (10.6–12.4) | 0.001 |
WBC count × 103 cells/μ/L | 8.2 (6.9–10.8) | 8.0 (6.74–10.8) | 8.7 (7.5–10.9) | 0.04 |
Platelet count × 103 cells/μ/L | 233.5 (190–311) | 230 (190–307) | 255 (194–319) | 0.622 |
CRP mg/L | 7.4 (2.1–41.2) | 6.1 (1.8–28.8) | 15.5 (2.8–61.2) | 0.019 |
CRP > 5 mg/L n (%) | 144 (60.3%) | 100 (56.2%) | 44 (72.1%) | 0.034 |
Creatinine μmol/L | 83 (67–102) | 81 (65.5–99) | 87 (68.8–110) | 0.22 |
eGFR | 74 (56–96) | 78 (57.3–98.8) | 65.5 (50.3–87.8) | 0.031 |
Preoperative hsTnT ng/L | 18 (12–29) | 17 (11–27) | 22 (14–35.5) | 0.017 |
NT-proBNP pg/ml median (Q1–Q3) | 558 (195–1565) | 459 (159–1365) | 1061 (471–2490) | < 0.001 |
All patients (n = 239) | Patients without myocardial injury (n = 178) | Patients with myocardial injury (n = 61) |
p value | |
---|---|---|---|---|
Death (up to 1 year) n% | 34 (14.2%) | 19 (10.7%) | 15 (24.6%) | 0.011 |
MI (up to 1 year) n% | 16 (6.7%) | 7 (3.9%) | 9 (14.8%) | 0.007 |
Stroke (up to 1 year) n% | 9 (3.8%) | 6 (3.3%) | 3 (4.9%) | 0.697 |
Composite end point (up to 1 year) n% | 48 (20.1%) | 27 (15.2%) | 21 (34.4%) | 0.003 |
Amputation below knee (up to 1 year) n% | 8 (3.3%) | 6 (3.4%) | 2 (3.2%) | 1 |
Amputation above knee (up to 1 year) n% | 23 (9.6%) | 18 (10.1%) | 5 (8.2%) | 0.804 |
Re-intervention (up to 1 year) n% | 106 (44.3%) | 83 (46.6%) | 23 (37.7%) | 0.237 |
Myocardial injury after endovascular revascularization
Myocardial injury and 1-year outcomes
Myocardial injury TnT threshold (ng/L) | Presence of myocardial injury* | ALL n = 239 | Death at 1-year | OR (95%CI) unadjusted |
p value | MACE | OR (95%CI) unadjusted |
p value |
---|---|---|---|---|---|---|---|---|
14 | No | 178 (74.5%) | 19 (10.7%) | Reference | 27 (15.1%) | Reference | ||
Yes | 61 (25.5%) | 15 (24.6%) | 2.73 (1.3–5.8) | 0.011 | 21 (34.4%) | 2.94 (1.50–5.73) | 0.003 | |
30 | No | 197 (82.4%) | 23 (11.7%) | Reference | 33 (16.8%) | Reference | ||
Yes | 42 (17.6%) | 11 (26.2%) | 2.68 (1.19–6.06) | 0.026 | 15 (35.7%) | 2.76 (1.33–5.75) | 0.01 | |
40 | No | 204 (85.4%) | 23 (11.3%) | Reference | 34 (16.7%) | Reference | ||
Yes | 35 (14.6%) | 11 (31.43%) | 3.61 (1.56–8.32) | 0.004 | 14 (40%) | 3.33 (1.54–7.20) | 0.003 | |
60 | No | 216 (90.4%) | 25 (11.6%) | Reference | 37 (17.1%) | Reference | ||
Yes | 23 (9.6%) | 9 (39.1%) | 4.91 (1.93–12.5) | 0.0016 | 11 (47.8%) | 4.43 (1.82–10.8) | 0.002 | |
80 | No | 222 (92.9%) | 27 (12.2%) | Reference | 38 (17.1%) | Reference | ||
Yes | 17 (7.1%) | 7 (41.2%) | 5.06 (1.78–14.4) | 0.004 | 10 (58.8%) | 6.92 (2.48–19.3) | < 0.001 |
1-year mortality | 1-year MACE | |||
---|---|---|---|---|
Adjusted hazard ratio (95% CI) |
p value | Adjusted OR (95% CI) |
p value | |
Age | 0.99 (0.95–1.033) | 0.653 | 0.99 (0.96–1.03) | 0.715 |
Sex | ||||
Female | Reference | Reference | ||
Male | 0.71 (0.31–1.64) | 0.426 | 0.84 (0.39–1.82) | 0.658 |
Rutherford | ||||
4 | Reference | Reference | ||
5 | 1.52 (0.50–4.59) | 0.461 | 1.259 (0.49–3.26) | 0.634 |
6 | 1.037 (0.26–4.17) | 0.959 | 0.888 (0.25–3.10) | 0.853 |
CAD | 1.64 (0.66–4.09) | 0.288 | 1.37 (0.56–3.35) | 0.492 |
History of MI | 0.87 (0.33–2.269) | 0.768 | 1.19 (0.47–3.04) | 0.714 |
DM | 0.89 (0.41–1.93) | 0.773 | 1.19 (0.57–2.48) | 0.639 |
CRP | 1.005 (0.999–1.011) | 0.087 | 1.004 (0.997–1.01) | 0.296 |
eGFR | 1.002 (0.991–1.014) | 0.719 | 0.9997 (0.9882–1.011) | 0.956 |
NT-proBNP | 1.00004 (0.999–1.00009) | 0.149 | 1.00005 (0.99998–1.00012) | 0.152 |
TnT0 | 1.002 (0.994–1.01) | 0.649 | 0.999 (0.987–1.011) | 0.868 |
Myocardial injury: hsTnT ≥ 14 ng/L with ≥ 30% relative hsTnT increase | 2.44 (1.18–5.06) | 0.016 | 2.89 (1.41–5.92) | 0.004 |
Myocardial injury TnT threshold* (ng/L) | 1-year mortality | 1-year MACE | ||||
---|---|---|---|---|---|---|
Adjusted hazard ratio (95% CI) |
p value | C-index | Adjusted OR (95% CI) |
p value | AUC | |
≥ 14 | 2.44 (1.18–5.06) | 0.016 | 0.7 | 2.89 (1.41–5.92) | 0.004 | 0.697 |
≥ 30 | 2.37 (1.09–5.17) | 0.03 | 0.694 | 2.67 (1.20–5.90) | 0.016 | 0.683 |
≥ 40 | 2.97 (1.35–6.55) | 0.007 | 0.705 | 3.09 (1.33–7.14) | 0.008 | 0.684 |
≥ 60 | 3.49 (1.49–8.14) | 0.004 | 0.698 | 3.98 (1.50–10.56) | 0.005 | 0.689 |
≥ 80 | 3.34 (1.29–8.65) | 0.013 | 0.694 | 6.692 (2.17–20.68) | 0.001 | 0.7 |