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Kragsterman, Björn
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Publications (10 of 33) Show all publications
Jönelid, B., Kragsterman, B., Berglund, L., Andrén, B., Johnston, N., Lindahl, B., . . . Christersson, C. (2019). Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease. JRSM Cardiovascular Disease, 8, 1-9
Open this publication in new window or tab >>Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease
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2019 (English)In: JRSM Cardiovascular Disease, ISSN 2048-0040, Vol. 8, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate whether the Walking Impairment Questionnaire score could identify patients with polyvascular disease in a population with recent myocardial infarction and their association with cardiovascular events during two-year follow-up.

Design: A prospective observational study.

Setting: Patients admitted to the acute coronary care unit, the Department of Cardiology, Uppsala University Hospital.

Participants: Patients admitted with acute Non-STEMI- or STEMI-elevation myocardial infarction.

Main outcome measures: The Walking Impairment Questionnaire, developed as a self-administered instrument to assess walking distance, speed, and stair climbing in patients with peripheral artery disease, predicts future cardiovascular events and mortality. Two hundred and sixty-three patients with recent myocardial infarction answered Walking Impairment Questionnaire. Polyvascular disease was defined as abnormal findings in the coronary- and carotid arteries and an abnormal ankle-brachial index. The calculated score for each of all three categories were divided into quartiles with the lowest score in first quartile.

Results: The lowest (worst) quartile in all three Walking Impairment Questionnaire categories was associated with polyvascular disease, fully adjusted; distance, odds ratio (OR) 5.4 (95% confidence interval (CI) 1.8-16.1); speed, OR 7.4 (95% CI 1.5-36.5); stair climbing, OR 8.4 (95% CI 1.0-73.6). In stair climbing score, patients with the lowest (worst) score had a higher risk for the composite cardiovascular endpoint compared to the highest (best) score; hazard ratio 5.3 (95% CI 1.5-19.0). The adherence to medical treatment was high (between 81.7% and 99.2%).

Conclusions: The Walking Impairment Questionnaire is a simple tool to identify myocardial infarction patients with more widespread atherosclerotic disease and although well treated medically, stair climbing predicts cardiovascular events.

Keywords
Peripheral vascular disease, cardiovascular disease, coronary artery disease, polyvascular disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-382843 (URN)10.1177/2048004019841971 (DOI)000464951000001 ()31019682 (PubMedID)
Available from: 2019-05-24 Created: 2019-05-24 Last updated: 2019-05-24Bibliographically approved
Kragsterman, B., Nordanstig, A., Lindström, D., Strömberg, S., Thuresson, M. & Nordanstig, J. (2018). Editor's Choice - Effect of More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A National Audit. European Journal of Vascular and Endovascular Surgery, 56(4), 467-474
Open this publication in new window or tab >>Editor's Choice - Effect of More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A National Audit
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2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 4, p. 467-474Article in journal (Refereed) Published
Abstract [en]

Background: The benefit of carotid endarterectomy (CEA) or stenting (CAS) for symptomatic stenosis depends on the timing in relation to the presenting event. As the risk of recurrent events is highest in the early phase, guidelines recommend a short delay. The purpose of this national audit was to study the effects of more expedient carotid intervention on the risk of recurrent ischaemic events. Methods: Data on all CEA and CAS for symptomatic stenosis, including both recurrent ischaemic events during the waiting time to carotid intervention and peri-operative 30 day complication rates, were obtained from the Swedish Vascular Registry between May 2008 and December 2015. The National Prescribed Drug Registry provided data on preventive medication prior to hospitalisation with the presenting event. The primary endpoint was a recurrent cerebral ischaemic event occurring after the presenting event up to 30 days of post-operative follow up. Results: A total of 6814 procedures for symptomatic carotid stenosis were studied. The proportion of recurrent ischaemic events, meaning all secondary events occurring after the presenting event up to 30 days follow up with inclusion of all pre- and post-intervention recurrences was recorded. These recurrent events decreased over time, from 31% in 2008-2009 to 21% in 2014-2015 (p < .01, chi-square test). In parallel, the median waiting time for carotid intervention decreased from 13 (IQR 6-27) to 7 days (IQR 4-12). Baseline demographic variables and comorbidities were similar during the study period. The proportion of pre-operative recurrences were reduced from 25% to 18% (p < .01, chi-square test) while the peri-operative stroke and/or death rate was 3.6%, and improved slightly during the study. Conclusions: A substantial reduction in the secondary ischaemic event rate was observed when the median waiting time for CEA/CAS was reduced, and this was not counterbalanced by any increase in the peri-operative complication rate. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
Carotid artery stenosis, Carotid endarterectomy, Carotid artery stenting, Stroke, Transient ischaemic attack
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-367398 (URN)10.1016/j.ejvs.2018.06.036 (DOI)000446392300003 ()30057011 (PubMedID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved
Fridh, E. B., Andersson, M., Thuresson, M., Sigvant, B., Kragsterman, B., Johansson, S., . . . Falkenberg, M. (2018). Editor's Choice - Impact of Comorbidity, Medication, and Gender on Amputation Rate Following Revascularisation for Chronic Limb Threatening Ischaemia. European Journal of Vascular and Endovascular Surgery, 56(5), 681-688
Open this publication in new window or tab >>Editor's Choice - Impact of Comorbidity, Medication, and Gender on Amputation Rate Following Revascularisation for Chronic Limb Threatening Ischaemia
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2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 5, p. 681-688Article in journal (Refereed) Published
Abstract [en]

Objective/background: Chronic limb threatening ischaemia (CLTI) has a high risk of amputation and mortality. Increased knowledge on how sex, comorbidities, and medication influence these outcomes after revascularisation may help optimise results and patient selection. Methods: This population based observational cohort study included all individuals revascularised for CLTI in Sweden during a five year period (10,617 patients in total). Data were retrieved and merged from mandatory national healthcare registries, and specifics on amputations were validated with individual medical records. Results: Mean age at revascularisation was 76.8 years. Median follow up was 2.7 years (range 0-6.6 years). Male sex (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09-1.33), renal insufficiency (HR 1.57, 95% CI 1.32-1.87), diabetes (HR 1.45, 95% CI 1.32-1.60), and heart failure (HR 1.17, 95% CI 1.05-1.31) were independently associated with an increased amputation rate, whereas the use of statins (HR 0.71, 95% CI 0.64-0.78) and low dose acetylsalicylic acid (HR 0.77, 95% CI 0.70-0.86) were associated with a reduced amputation rate. For the combined end point of amputation or death, an association with increased rates was found for male sex (HR 1.25, 95% CI 1.18-1.32), renal insufficiency (HR 1.94, 95% CI 1.75-2.14), heart failure (HR 1.50, 95% CI 1.40-1.60), and diabetes (HR 1.31, 95% CI 1.23-1.38). The use of statins (HR 0.74, 95% CI 0.67-0.82) and low dose acetylsalicylic acid (HR 0.82, 95% CI 0.77-0.881) were related to a reduced risk of amputation or death. Conclusions: Renal insufficiency is the strongest independent risk factor for both amputation and amputation/ death in revascularised CLTI patients, followed by diabetes and heart failure. Men with CLTI have worse outcomes than women. These results may help govern patient selection for revascularisation procedures. Statin and low dose acetylsalicylic acid are associated with an improved limb outcome. This underlines the importance of preventive medication to reduce general cardiovascular risk and increase limb salvage.

Keywords
Amputation, Arterial occlusive diseases, Atherosclerosis, Comorbidity, Mortality, Peripheral arterial disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-369610 (URN)10.1016/j.ejvs.2018.06.003 (DOI)000448805800018 ()30093176 (PubMedID)
Funder
AstraZeneca
Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2018-12-14Bibliographically approved
Hasvold, P., Nordanstig, J., Kragsterman, B., Kristensen, T., Falkenberg, M., Johansson, S., . . . Sigvant, B. (2018). Long-term cardiovascular outcome, use of resources, and healthcare costs in patients with peripheral artery disease: results from a nationwide Swedish study. European Heart Journal - Quality of Care and Clinical Outcomes, 4(1), 10-17
Open this publication in new window or tab >>Long-term cardiovascular outcome, use of resources, and healthcare costs in patients with peripheral artery disease: results from a nationwide Swedish study
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2018 (English)In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 4, no 1, p. 10-17Article in journal (Refereed) Published
Abstract [en]

Aims: Data on long-term healthcare costs of patients with peripheral artery disease (PAD) is limited, and the aim of this study was to investigate healthcare costs for PAD patients at a nationwide level.

Methods and results: A cohort study including all incident patients diagnosed with PAD in the Swedish National Patient Register between 2006-2014, and linked to cause of death-and prescribed drug registers. Mean per-patient annual healthcare costs (2015 Euros (sic)) (hospitalisations and out-patient visits) were divided into cardiovascular (CV), lower limb and non-CV related cost. Results were stratified by high and low CV risk. The study included 66,189 patients, with 221,953 observation-years. Mean total healthcare costs were (sic)6,577, of which 26% was CV-related ((sic)1,710), during the year prior to the PAD diagnosis. First year after PAD diagnosis, healthcare costs were (sic)12,549, of which (sic)3,824 (30%) was CV-related and (sic)3,201 (26%) lower limb related. Highrisk CV patients had a higher annual total healthcare and CV related costs compared to low risk CV patients during follow-up ((sic)7,439 and (sic)1,442 versus (sic)4,063 and (sic)838). Annual lower limb procedure costs were (sic)728 in the PAD population, with lower limb revascularisations as key cost driver ((sic)474).

Conclusion: Non-CV related hospitalizations and outpatient visits were the largest cost contributors for PAD patients. There is a substantial increase in healthcare costs in the first year after being diagnosed with PAD, driven by PAD follow-up and lower limb related procedures. Among the CV-related costs, hospitalisations and outpatient visits related to PAD represented the largest costs.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
Keywords
Nationwide register data, peripheral artery disease, healthcare resource use, healthcare costs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-343391 (URN)10.1093/ehjqcco/qcx028 (DOI)000422967400005 ()28950310 (PubMedID)
Funder
AstraZeneca
Available from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-02-28Bibliographically approved
Fridh, E. B., Andersson, M., Thuresson, M., Sigvant, B., Kragsterman, B., Johansson, S., . . . Nordanstig, J. (2017). Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study. European Journal of Vascular and Endovascular Surgery, 54(4), 480-486
Open this publication in new window or tab >>Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study
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2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 4, p. 480-486Article in journal (Refereed) Published
Abstract [en]

Objectives: The aims of this population based study were to describe mid-to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD).

Methods: This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations.

Results: A total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%-0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3-12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0-13.9) in IC patients and 48.8% (95% CI 47.7-49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation.

Conclusion: The risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2017
Keywords
Arterial occlusive diseases, Peripheral arterial disease, Intermittent claudication, Mortality, Amputation, Comorbidity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-338525 (URN)10.1016/j.ejvs.2017.07.005 (DOI)000412967500016 ()28797662 (PubMedID)
Funder
AstraZeneca
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-10Bibliographically approved
Sigvant, B., Hasvold, P., Kragsterman, B., Falkenberg, M., Johansson, S., Thuresson, M. & Nordanstig, J. (2017). Cardiovascular outcomes in patients with peripheral arterial disease as an initial or subsequent manifestation of atherosclerotic disease: Results from a Swedish nationwide study. Journal of Vascular Surgery, 66(2), 507-514e1
Open this publication in new window or tab >>Cardiovascular outcomes in patients with peripheral arterial disease as an initial or subsequent manifestation of atherosclerotic disease: Results from a Swedish nationwide study
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2017 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 66, no 2, p. 507-514e1Article in journal (Refereed) Published
Abstract [en]

Objective: Long-term progression of peripheral arterial disease (PAD) as initial manifestation of atherosclerotic arterial disease is not well described. Cardiovascular (CV) risk was examined in different PAD populations diagnosed in a hospital setting in Sweden. Methods: Data for this retrospective cohort study were retrieved by linking data on morbidity, medication use, and mortality from Swedish national registries. Primary CV outcome was a composite of myocardial infarction, ischemic stroke (IS), and CV death. Kaplan-Meier analysis and Cox proportional hazards modeling was used for describing risk and relative risk. Results: Of 66,189 patients with an incident PAD diagnosis (2006-2013), 40,136 had primary PAD, 16,786 had PAD _ coronary heart disease (CHD), 5803 had PAD _IS, and 3464 had PAD _IS _CHD. One-year cumulative incidence rates of major CV events for the groups were 12%, 21%, 29%, and 34%, respectively. Corresponding numbers for 1-year all-cause death were 16%, 22%, 33%, and 35%. Compared with the primary PAD population, the relative risk increase for CV events was highest in patients with PAD _IS _CHD (hazard ratio [HR], 2.01), followed by PAD _IS (HR, 1.87) and PAD _ CHD (HR, 1.42). Despite being younger, the primary PAD population was less intensively treated with secondary preventive drug therapy. Conclusions: PAD as initial manifestation of atherosclerotic disease diagnosed in a hospital-based setting conferred a high risk: one in eight patients experienced a major CV event and one in six patients died within 1 year. Despite younger age and substantial risk of future major CV events, patients with primary PAD received less intensive secondary preventive drug therapy.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2017
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-334495 (URN)10.1016/j.jvs.2017.01.067 (DOI)000408218200100 ()28433332 (PubMedID)
Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-01-11Bibliographically approved
Kragsterman, B., Bergqvist, D., Siegbahn, A. & Pärsson, H. (2017). Carotid Endarterectomy Induces the Release of Inflammatory Markers and the Activation of Coagulation as Measured in the Jugular Bulb. Journal of Stroke & Cerebrovascular Diseases, 26(10), 2320-2328
Open this publication in new window or tab >>Carotid Endarterectomy Induces the Release of Inflammatory Markers and the Activation of Coagulation as Measured in the Jugular Bulb
2017 (English)In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 26, no 10, p. 2320-2328Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: Transient cerebral hypoxia may induce neuronal injury through an ischemia-reperfusion (I/R) response, with a subsequent activation of inflammation and coagulation-fibrinolysis. During carotid endarterectomy (CEA), the artery is clamped, which might impair the regional cerebral perfusion and initiate a local I/R response. Data suggest that the CD40-CD40 ligand dyad acts as a modulator in the induced activation. The aim of this study was to locally measure soluble CD40 ligand (sCD40L), in conjunction with inflammation and coagulation activation markers, during CEA.

Subjects and Methods: This is a prospective study of 18 patients undergoing CEA. Blood samples from the venous jugular bulb (JB) and the radial artery (RA) were drawn at baseline and during the procedure. Measurements of sCD40L, interleukin-6 (IL-6), fragment 1 + 2 (F1 + 2), plasminogen activator inhibitor-1 (PAI-1), and D-dimer were analyzed. Comparisons during CEA were made between levels: baselines versus JB, JB versus RA, and sequential JB measurements. Fifty cardiovascular healthy patients were the reference group for the sCD40L baseline comparison.

Results: Increased cerebral IL-6 levels were demonstrated throughout the procedure, as well as the temporal influence in F1 + 2, PAI-1, and D-dimer values. sCD40L remained unchanged throughout the procedure. This indicates a local cerebral inflammatory reaction together with an activation of coagulation-fibrinolysis, but it does not appear to primarily involve the CD40-CD40 ligand dyad.

Conclusions: Signs of a local inflammatory reaction and activation of coagulation were observed during CEA, but levels of sCD40L remained stable, unaffected by carotid artery clamping and reperfusion.

Keywords
Carotid endarterectomy, carotid clamping, cerebral perfusion, cerebral ischemia
National Category
Cardiac and Cardiovascular Systems Neurology
Identifiers
urn:nbn:se:uu:diva-341672 (URN)10.1016/j.jstrokecerebrovasdis.2017.05.020 (DOI)000414535300041 ()28652057 (PubMedID)
Available from: 2018-02-13 Created: 2018-02-13 Last updated: 2018-02-13Bibliographically approved
Jönelid, B., Johnston, N., Berglund, L., Andrén, B., Kragsterman, B. & Christersson, C. (2016). Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction. European journal of internal medicine, 30, 55-60
Open this publication in new window or tab >>Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction
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2016 (English)In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 30, p. 55-60Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Atherosclerosis is a systemic disease. In patients with acute myocardial infarction (MI) the extent of polyvascular disease (PvD) is largely unknown. In this study we investigate the prevalence and clinical characteristics predictive of PvD in patients with non-ST-elevation (NSTEMI) and ST-elevation (STEMI) MI.

METHOD: 375 patients with acute MI included in the REBUS (Relevance of Biomarkers for Future Risk of Thromboembolic Events in Unselected Post-myocardial Infarction Patients) study were examined. Atherosclerotic changes were assessed in three arterial beds by coronary angiography, carotid ultrasound and ankle brachial index (ABI). Results compared findings of atherosclerosis in three arterial beds to fewer than 3 beds. PvD was defined as atherosclerosis in all three arterial beds.

RESULTS: A medical history of MI, peripheral artery disease (PAD) or stroke was reported at admission in 17.9%, 2.1% and 3.7% of the patients, respectively. After evaluation, abnormal ABI was found in 20.3% and carotid artery atherosclerosis in 54.9% of the patients. In the total population, PvD was found in 13.8% of patients with no significant differences observed between NSTEMI and STEMI patients. Age (p<0.001), diabetes (p=0.039), previous PAD (p=0.009) and female gender (p=0.016) were associated with PvD. ABI was the most important predictor of PvD with a positive predictive value of 68.4% (95% CI 57.7-79.2%) and specificity of 92.4% (95% CI 89.5-95.4%).

CONCLUSIONS: PvD is underdiagnosed in patients suffering from MI, both NSTEMI and STEMI. ABI is a useful and simple measurement that appears predictive of widespread atherosclerosis in these patients.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-274195 (URN)10.1016/j.ejim.2015.12.016 (DOI)000375919800022 ()26776925 (PubMedID)
Available from: 2016-01-20 Created: 2016-01-20 Last updated: 2018-01-10Bibliographically approved
Sigvant, B., Kragsterman, B., Falkenberg, M., Hasvold, L. P., Johansson, S., Thuresson, M. & Nordanstig, J. (2016). Cardiovascular outcome in patients with peripheral artery disease (pad) as initial manifestation of atherosclerotic disease compared with patients with pad as subsequent diagnosis after coronary heart. In: : . Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY (pp. 796-797). , 37
Open this publication in new window or tab >>Cardiovascular outcome in patients with peripheral artery disease (pad) as initial manifestation of atherosclerotic disease compared with patients with pad as subsequent diagnosis after coronary heart
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2016 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-313878 (URN)000383869504034 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY
Available from: 2017-01-25 Created: 2017-01-25 Last updated: 2017-01-25Bibliographically approved
Sigvant, B., Kragsterman, B., Falkenberg, M., Hasvold, P., Johansson, S., Thuresson, M. & Nordanstig, J. (2016). Contemporary cardiovascular risk and secondary preventive drug treatment patterns in peripheral artery disease patients undergoing revascularization. Journal of Vascular Surgery, 64(4), 1009-1017.e3
Open this publication in new window or tab >>Contemporary cardiovascular risk and secondary preventive drug treatment patterns in peripheral artery disease patients undergoing revascularization
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2016 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 64, no 4, p. 1009-1017.e3Article in journal (Refereed) Published
Abstract [en]

Objective: Peripheral artery disease (PAD) is common worldwide, and PAD patients are increasingly offered lower limb revascularization procedures. The aim of this population-based study was to describe the current risk for cardiovascular (CV) events and mortality and also to elucidate the current pharmacologic treatment patterns in revascularized lower limb PAD patients. Methods: This observational, retrospective cohort study analyzed prospectively collected linked data retrieved from mandatory Swedish national health care registries. The Swedish National Registry for Vascular Surgery database was used to identify revascularized PAD patients. Current risk for CV events and death was analyzed, as were prescribed drugs aimed for secondary prevention. A Cox proportional hazard regression model was used to explore risk factors for suffering a CV event. Results: Between May 2008 and December 2013, there were 18,742 revascularized PAD patients identified. Mean age was 70.0 years among patients with intermittent claudication (IC; n = 6959) and 76.8 years among patients with critical limb ischemia (CLI; n = 11,783). Antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and beta-blockers were used by 73%, 60%, 57%, and 49% at admission for revascularization. CV event rate (a composite of myocardial infarction, ischemic stroke, or CV death) at 12, 24, and 36 months was 5.1% (95% confidence interval [CI], 4.5-5.6), 9.5% (95% CI, 8.7-10.3), and 13.8% (95% CI, 12.8-14.8) in patients with IC and 16.8% (95% CI, 16.1-17.6), 25.9% (95% CI, 25.0-26.8), and 34.3% (95% CI, 33.2-35.4) in patients with CLI. Best medical treatment, defined as any antiplatelet or anticoagulant therapy along with statin treatment, was offered to 65% of IC patients and 45% of CLI patients with little change during the study period. Statin therapy was associated with reduced CV events (hazard ratio, 0.76; 95% CI, 0.71-0.81; P < .001), whereas treatment with low-dose aspirin was not. Conclusions: Revascularized PAD patients are still at a high risk for CV events without a declining time trend. A large proportion of both IC and CLI patients were not offered best medical treatment. The most commonly used agent was aspirin, which was not associated with CV event reduction. This study calls for improved medical management and highlights an important and partly unmet medical need among revascularized PAD patients.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-313003 (URN)10.1016/j.jvs.2016.03.429 (DOI)000389513400020 ()27209402 (PubMedID)
Available from: 2017-01-23 Created: 2017-01-16 Last updated: 2017-11-29Bibliographically approved
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