Skip to main content
Erschienen in:

17.04.2024 | Original Article

Two-year outcomes of endovascular therapy for femoropopliteal arterial lesions for patients with high bleeding risk

verfasst von: Yuki Shima, Narumi Taninobu, Akihiro Ikuta, Kazunori Mushiake, Hiroyuki Tanaka, Kazushige Kadota

Erschienen in: Cardiovascular Intervention and Therapeutics | Ausgabe 3/2024

Einloggen, um Zugang zu erhalten

Abstract

The Academic Research Consortium (ARC) recently published a definition of patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention. However, the prevalence of the ARC-HBR criteria in patients undergoing endovascular therapy (EVT) for femoropopliteal arterial lesions has not been thoroughly investigated. The study population comprised 165 patients undergoing initial EVT for femoropopliteal lesions between June 2018 and June 2020. They were divided into two groups according to the ARC-HBR criteria. The primary end point was a composite of all-cause death, Bleeding Academic Research Consortium type 3 or 5 bleeding, and target lesion revascularization (TLR) within 2 years of EVT. The 165 patients were divided into two groups: 125 (75.8%) patients at HBR (HBR group) and 40 (24.2%) patients at no HBR (non-HBR group). The cumulative incidence of the primary endpoint was significantly higher in the HBR group than in the non-HBR group (40.6% vs. 0%, log-rank p < 0.001). The HBR group had a significantly higher risk of all-cause death, major bleeding, and TLR than the non-HBR group (25.2% vs. 0%, log-rank p = 0.004, 13.9% vs. 0%, log-rank p = 0.047, 16.8% vs. 0%, log-rank p = 0.035). Most patients with peripheral artery disease were classified as HBR patients, and HBR patients were at higher risk of death, major bleeding, and TLR than non-HBR patients.

Graphical abstract

Literatur
1.
Zurück zum Zitat Bhardwaj B, Spertus JA, Kennedy KF, Jones WS, Safey D, Tsai TT, et al. Bleeding complications in lower-extremity peripheral vascular interventions: insights from the NCDR PVI registry. JACC Cardiovasc Interv. 2019;12:1140–9.CrossRefPubMedPubMedCentral Bhardwaj B, Spertus JA, Kennedy KF, Jones WS, Safey D, Tsai TT, et al. Bleeding complications in lower-extremity peripheral vascular interventions: insights from the NCDR PVI registry. JACC Cardiovasc Interv. 2019;12:1140–9.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019;40:2632–53.CrossRefPubMedPubMedCentral Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019;40:2632–53.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Cao D, Mehran R, Dangas G, Baber U, Sartori S, Chandiramani R, et al. Validation of the Academic Research Consortium high bleeding risk defnition in contemporary PCI patients. J Am Coll Cardiol. 2020;75:2711–22.CrossRefPubMed Cao D, Mehran R, Dangas G, Baber U, Sartori S, Chandiramani R, et al. Validation of the Academic Research Consortium high bleeding risk defnition in contemporary PCI patients. J Am Coll Cardiol. 2020;75:2711–22.CrossRefPubMed
4.
Zurück zum Zitat Natsuaki M, Morimoto T, Shiomi H, Yamaji K, Watanabe H, Shizuta S, et al. Application of the Academic Research Consortium high bleeding risk criteria in an all-comers registry of percutaneous coronary intervention. Circ Cardiovasc Interv. 2019;12(11):e008307.CrossRefPubMed Natsuaki M, Morimoto T, Shiomi H, Yamaji K, Watanabe H, Shizuta S, et al. Application of the Academic Research Consortium high bleeding risk criteria in an all-comers registry of percutaneous coronary intervention. Circ Cardiovasc Interv. 2019;12(11):e008307.CrossRefPubMed
5.
Zurück zum Zitat Miura K, Shimada T, Ohya M, Murai R, Amano H, Kubo S, et al. Prevalence of the academic research consortium for high bleeding risk criteria and prognostic value of a simplifed defnition. Circ J. 2020;84:1560–7.CrossRefPubMed Miura K, Shimada T, Ohya M, Murai R, Amano H, Kubo S, et al. Prevalence of the academic research consortium for high bleeding risk criteria and prognostic value of a simplifed defnition. Circ J. 2020;84:1560–7.CrossRefPubMed
6.
Zurück zum Zitat Nakamura M, Kadota K, Nakao K, Nakagawa Y, Shite J, Yokoi H, et al. High bleeding risk and clinical outcomes in East Asian patients undergoing percutaneous coronary intervention: the PENDULUM Registry. EuroIntervention. 2021;16:1154–62.CrossRefPubMedPubMedCentral Nakamura M, Kadota K, Nakao K, Nakagawa Y, Shite J, Yokoi H, et al. High bleeding risk and clinical outcomes in East Asian patients undergoing percutaneous coronary intervention: the PENDULUM Registry. EuroIntervention. 2021;16:1154–62.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Shima Y, Miura K, Shimada T, Ohya M, Murai R, Kubo S, et al. Impact of ischemic risk factors on long-term outcomes in patients with and without high bleeding risk. Int J Cardiol. 2021;326:12–8.CrossRefPubMed Shima Y, Miura K, Shimada T, Ohya M, Murai R, Kubo S, et al. Impact of ischemic risk factors on long-term outcomes in patients with and without high bleeding risk. Int J Cardiol. 2021;326:12–8.CrossRefPubMed
8.
Zurück zum Zitat Ueki Y, Bär S, Losdat S, Otsuka T, Zanchin C, Zanchin T, et al. Validation of the Academic Research Consortium for high bleeding risk (ARC-HBR) criteria in patients undergoing percutaneous coronary intervention and comparison with contemporary bleeding risk scores. EuroIntervention. 2020;16:371–9.CrossRefPubMed Ueki Y, Bär S, Losdat S, Otsuka T, Zanchin C, Zanchin T, et al. Validation of the Academic Research Consortium for high bleeding risk (ARC-HBR) criteria in patients undergoing percutaneous coronary intervention and comparison with contemporary bleeding risk scores. EuroIntervention. 2020;16:371–9.CrossRefPubMed
9.
Zurück zum Zitat Hashimoto R, Numasawa Y, Yokokura S, Daigo K, Sakata S, Imaeda S, et al. Prevalence of the Academic Research Consortium high bleeding risk criteria in patients undergoing endovascular therapy for peripheral artery disease in lower extremities. Heart Vessels. 2021;36:1350–8.CrossRefPubMed Hashimoto R, Numasawa Y, Yokokura S, Daigo K, Sakata S, Imaeda S, et al. Prevalence of the Academic Research Consortium high bleeding risk criteria in patients undergoing endovascular therapy for peripheral artery disease in lower extremities. Heart Vessels. 2021;36:1350–8.CrossRefPubMed
10.
Zurück zum Zitat Yoshioka N, Takagi K, Morita Y, Kanzaki Y, Nagai H, Watanabe N, et al. Bleeding events and mid-term mortality in the patients undergoing endovascular interventions for peripheral artery disease of the lower limbs based on the academic research consortium high bleeding risk criteria. Heart Vessels. 2021;36:1336–49.CrossRefPubMed Yoshioka N, Takagi K, Morita Y, Kanzaki Y, Nagai H, Watanabe N, et al. Bleeding events and mid-term mortality in the patients undergoing endovascular interventions for peripheral artery disease of the lower limbs based on the academic research consortium high bleeding risk criteria. Heart Vessels. 2021;36:1336–49.CrossRefPubMed
11.
Zurück zum Zitat Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding defnitions for cardiovascular clinical trials: a consensus report from the bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefPubMed Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding defnitions for cardiovascular clinical trials: a consensus report from the bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefPubMed
12.
Zurück zum Zitat Soga Y, Iida O, Takahara M, Hirano K, Suzuki K, Kawasaki D, et al. Two-year life expectancy in patients with critical limb ischemia. JACC Cardiovasc Interv. 2014;7:1444–9.CrossRefPubMed Soga Y, Iida O, Takahara M, Hirano K, Suzuki K, Kawasaki D, et al. Two-year life expectancy in patients with critical limb ischemia. JACC Cardiovasc Interv. 2014;7:1444–9.CrossRefPubMed
13.
Zurück zum Zitat Guo X, Xue G, Huang X, Xie H, Liang W, Zhang J, et al. Outcomes of endovascular treatment for patients with TASC II D femoropopliteal occlusive disease: a single center study. BMC Cardiovasc Disord. 2015;15:44.CrossRefPubMedPubMedCentral Guo X, Xue G, Huang X, Xie H, Liang W, Zhang J, et al. Outcomes of endovascular treatment for patients with TASC II D femoropopliteal occlusive disease: a single center study. BMC Cardiovasc Disord. 2015;15:44.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Khan MS, Zou F, Khan AR, Moustafa A, Schmid CH, Baig M, et al. Meta-analysis comparing endovascular treatment modalities for femoropopliteal peripheral artery disease. Am J Cardiol. 2020;128:181–8.CrossRefPubMed Khan MS, Zou F, Khan AR, Moustafa A, Schmid CH, Baig M, et al. Meta-analysis comparing endovascular treatment modalities for femoropopliteal peripheral artery disease. Am J Cardiol. 2020;128:181–8.CrossRefPubMed
15.
Zurück zum Zitat Takahara M, Iida O, Kohsaka S, Soga Y, Fujihara M, Shinke T, et al. Diabetes mellitus and other cardiovascular risk factors in lower-extremity peripheral artery disease versus coronary artery disease: an analysis of 1,121,359 cases from the nationwide databases. Cardiovasc Diabetol. 2019;18:155.CrossRefPubMedPubMedCentral Takahara M, Iida O, Kohsaka S, Soga Y, Fujihara M, Shinke T, et al. Diabetes mellitus and other cardiovascular risk factors in lower-extremity peripheral artery disease versus coronary artery disease: an analysis of 1,121,359 cases from the nationwide databases. Cardiovasc Diabetol. 2019;18:155.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Numasawa Y, Inohara T, Ishii H, Kuno T, Kodaira M, Kohsaka S, et al. Comparison of outcomes of women versus men with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention (from the Japanese nationwide registry). Am J Cardiol. 2017;119(6):826–31.CrossRefPubMed Numasawa Y, Inohara T, Ishii H, Kuno T, Kodaira M, Kohsaka S, et al. Comparison of outcomes of women versus men with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention (from the Japanese nationwide registry). Am J Cardiol. 2017;119(6):826–31.CrossRefPubMed
17.
Zurück zum Zitat Chandiramani R, Cao D, Claessen BE, Sorrentino S, Guedeney P, Blum M, et al. Sex-related differences in patients at high bleeding risk undergoing percutaneous coronary intervention: a patient-level pooled analysis from 4 postapproval studies. J Am Heart Assoc. 2020;9:e014611.CrossRefPubMedPubMedCentral Chandiramani R, Cao D, Claessen BE, Sorrentino S, Guedeney P, Blum M, et al. Sex-related differences in patients at high bleeding risk undergoing percutaneous coronary intervention: a patient-level pooled analysis from 4 postapproval studies. J Am Heart Assoc. 2020;9:e014611.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Takeji Y, Yamaji K, Tomoi Y, Okazaki J, Tanaka K, Nagae A, et al. Impact of frailty on clinical outcomes in patients with critical limb ischemia. Circ Cardiovasc Interv. 2018;11:e006778.CrossRefPubMed Takeji Y, Yamaji K, Tomoi Y, Okazaki J, Tanaka K, Nagae A, et al. Impact of frailty on clinical outcomes in patients with critical limb ischemia. Circ Cardiovasc Interv. 2018;11:e006778.CrossRefPubMed
20.
Zurück zum Zitat Gebauer K, Engelbertz C, Malyar NM, Meyborg M, Lüders F, Freisinger E, et al. Long-term mortality after invasive angiography and endovascular revascularization in patients with PAD having chronic kidney disease. Angiology. 2016;67:556–64.CrossRefPubMed Gebauer K, Engelbertz C, Malyar NM, Meyborg M, Lüders F, Freisinger E, et al. Long-term mortality after invasive angiography and endovascular revascularization in patients with PAD having chronic kidney disease. Angiology. 2016;67:556–64.CrossRefPubMed
21.
Zurück zum Zitat Senthong V, Wu Y, Hazen SL, Tang WH. Predicting longterm prognosis in stable peripheral artery disease with baseline functional capacity estimated by the Duke Activity Status Index. Am Heart J. 2017;184:17–25.CrossRefPubMed Senthong V, Wu Y, Hazen SL, Tang WH. Predicting longterm prognosis in stable peripheral artery disease with baseline functional capacity estimated by the Duke Activity Status Index. Am Heart J. 2017;184:17–25.CrossRefPubMed
22.
Zurück zum Zitat Soga Y, Iida O, Takahara M, Takahaera M, Hirano K, Suzuki K, et al. Two-year life expectancy in patients with critical limb ischemia. JACC Cardiovasc Interv. 2014;7:1444–9.CrossRefPubMed Soga Y, Iida O, Takahara M, Takahaera M, Hirano K, Suzuki K, et al. Two-year life expectancy in patients with critical limb ischemia. JACC Cardiovasc Interv. 2014;7:1444–9.CrossRefPubMed
23.
Zurück zum Zitat Shiraki T, Iida O, Takahara M, Masuda M, Okamoto S, Ishihara T, et al. The geriatric nutritional risk index is independently associated with prognosis in patients with critical limb ischemia following endovascular therapy. Eur J Vasc Endovasc Surg. 2016;52:218–24.CrossRefPubMed Shiraki T, Iida O, Takahara M, Masuda M, Okamoto S, Ishihara T, et al. The geriatric nutritional risk index is independently associated with prognosis in patients with critical limb ischemia following endovascular therapy. Eur J Vasc Endovasc Surg. 2016;52:218–24.CrossRefPubMed
24.
Zurück zum Zitat Garimella PS, Hirsch AT. Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes. Adv Chronic Kidney Dis. 2014;21:460–71.CrossRefPubMedPubMedCentral Garimella PS, Hirsch AT. Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes. Adv Chronic Kidney Dis. 2014;21:460–71.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67:2224–34.CrossRefPubMed Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67:2224–34.CrossRefPubMed
26.
Zurück zum Zitat Ward R, Huang Z, Rockhold FW, Baumgartner I, Berger JS, Blomster JI, et al. Major bleeding in patients with peripheral artery disease: insights from the EUCLID trial. Am Heart J. 2020;220:51–8.CrossRefPubMed Ward R, Huang Z, Rockhold FW, Baumgartner I, Berger JS, Blomster JI, et al. Major bleeding in patients with peripheral artery disease: insights from the EUCLID trial. Am Heart J. 2020;220:51–8.CrossRefPubMed
27.
Zurück zum Zitat Spiliopoulos S, Tsochatzis A, Festas G, Reppas L, Christidi F, Palialexis K, et al. A new preprocedural score to predict bleeding complications of endovascular interventions for peripheral artery disease. J Endovasc Ther. 2019;26:816–25.CrossRefPubMed Spiliopoulos S, Tsochatzis A, Festas G, Reppas L, Christidi F, Palialexis K, et al. A new preprocedural score to predict bleeding complications of endovascular interventions for peripheral artery disease. J Endovasc Ther. 2019;26:816–25.CrossRefPubMed
28.
Zurück zum Zitat Matsi PJ, Manninen HI. Complications of lower-limb percutaneous transluminal angioplasty: a prospective analysis of 410 procedures on 295 consecutive patients. Cardiovasc Intervent Radiol. 1998;21:361–6.CrossRefPubMed Matsi PJ, Manninen HI. Complications of lower-limb percutaneous transluminal angioplasty: a prospective analysis of 410 procedures on 295 consecutive patients. Cardiovasc Intervent Radiol. 1998;21:361–6.CrossRefPubMed
Metadaten
Titel
Two-year outcomes of endovascular therapy for femoropopliteal arterial lesions for patients with high bleeding risk
verfasst von
Yuki Shima
Narumi Taninobu
Akihiro Ikuta
Kazunori Mushiake
Hiroyuki Tanaka
Kazushige Kadota
Publikationsdatum
17.04.2024
Verlag
Springer Nature Singapore
Erschienen in
Cardiovascular Intervention and Therapeutics / Ausgabe 3/2024
Print ISSN: 1868-4300
Elektronische ISSN: 1868-4297
DOI
https://doi.org/10.1007/s12928-024-00999-2

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Kardiologie

Auf einen Myokardinfarkt folgt häufig eine Herzinsuffizienz

Ein erneuter Myokardinfarkt sowie die Entwicklung einer Herzinsuffizienz sind wesentliche Komplikationen nach einem akuten Myokardinfarkt. Eine US-amerikanische Studie zeigt insbesondere ein hohes Risiko für die Entwicklung einer Herzinsuffizienz auf, von der nahezu ein Viertel der Patienten betroffen war.

Nach Herzinfarkt zurück ans Steuer: Braucht es ein befristetes Fahrverbot?

Wann sollten sich Menschen nach überstandenem Myokardinfarkt wieder ans Steuer eines Autos setzen dürfen? Eine Studie aus Kanada liefert aktuelle Daten zur Wahrscheinlichkeit kardial bedingter plötzlicher Kontrollverluste als Basis für entsprechende Empfehlungen.

Vorhofflimmern, Bluthochdruck und mehr: Das waren die Top-News 2024

Ablation, Vorhofohr-Verschluss und Antikoagulation bei Vorhofflimmern, TAVI bei asymptomatischer Aortenstenose – nicht nur dazu brachten Studien 2024 neue Erkenntnisse. Leitlinien-Updates etwa zum Hypertonie-Management gab es auch.

Hochsensitive Tests auf kardiale Troponine T und I nicht gleichwertig

Ob beim Verdacht auf einen NSTEMI ein hochsensitiver Test auf kardiales Troponin T oder I zum Einsatz kommt, hat laut einer Sekundäranalyse der APACE-Studie Konsequenzen für die Genauigkeit von Diagnose und Prognose. 

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.