The 5-year follow-up of the I-PAD NAGANO registry showed that patients with intermittent claudication who underwent EVT and had an ABI ≤0.5 had a poor prognosis, but patients with higher ABI may also have a poor prognosis depending on comorbidities, according to Dr. Yoshiteru Okina of Joetsu General Hospital, who presented this research at the Poster session at the 86th annual meeting of the Japanese Cardiovascular Society.
The Impact of ABI on Prognosis After EVT in Patients with Intermittent Claudication: 5-Year Follow-Up of the I-PAD NAGANO Registry
The I-PAD NAGANO registry prospectively enrolled 366 consecutive patients (463 lesions) who underwent EVT for peripheral arterial disease from 11 facilities in Japan, primarily in the Nagano Prefecture, from August 2015 to August 2016. The study included 240 patients with intermittent claudication, classified into 8 groups according to ABI before EVT (≤0.04: 14 patients, 0.41-0.50: 17 patients, 0.51-0.60: 55 patients, 0.61-0.70: 59 patients, 0.71-0.80: 48 patients, 0.81-0.90: 21 patients, 0.91-0.99: 11 patients, ≥1.00: 13 patients) and the impact of ABI on prognosis.
From the 5-year follow-up, the rates of MACLE (all-cause mortality, MI, stroke, and major amputation of the lower extremity), at the primary endpoint, were significantly higher in the ≤0.4 group (50.0%), the 0.41-0.5 group (41.2%), and the 0.91-0.99 group (45.5%) as compared to the 0.51-0.60 group (25.9%), the 0.61-0.70 group (22.4%), the 0.71-0.80 group (17.0%) (p=0.045). The clinical frail score was higher in the 0.91-0.99 group due to the higher proportion of atrial fibrillation patients.
The multivariate Cox regression analysis showed that predictors of MACLE included age (HR 1.04 [95% CI 1.00-1.08] p=0.03), BMI (HR 0.87 [95% CI 0.80-0.95] p=0.002), clinical frailty score (HR 1.33 [95% CI 1.13-1.56] p< 0.001), diabetes mellitus (HR 1.67 [95% CI 1.00-2.79] p=0.05), OMI (HR 1.91 [95% CI 1.06-3.44] p=0.03), dialysis (HR 3.16 [95% CI 1.85-5.41] p<0.001), heart failure (HR 2.14 [95% CI 1.11-4.16] p=0.02) were identified. On the other hand, ABI was not found to be a prognostic predictor of MACLE.
Dr. Okina summarized, “Patients with an ABI ≤0.50 had a poor prognosis after EVT. However, even patients with borderline ABI values may have a poor prognosis depending on comorbidities.”
The 86th Annual Scientific Meeting of the Japanese Circulation Society
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