背景:外周动脉疾病(PAD)和微血管疾病(MVD)是非常普遍的疾病,具有共同的危险因素。这项观察性研究旨在表征两种情况的患者,并确定PAD/MVD合并症对结局的影响。
结果:从国家再入院数据库中纳入2011年1月至2018年12月31个州的原发性或继发性诊断为PAD或MVD的患者,并加权至接近全国样本。年龄<18岁或非动脉粥样硬化性腿部损伤者除外。患者分为3组:仅PAD,仅MVD,或PAD/MVD合并症。多元逻辑回归用于评估与主要和次要截肢的关联,主要不良心脏事件,和住院死亡率。Cox回归用于评估与1年内再入院的关联。PAD组作为参考。最终队列包括33972772入院:910万患有PAD,2130万MVD,两者都有360万。2018年,PAD/MVD的年录取率增加到>50万。2011年至2018年间,PAD/MVD的主要和次要截肢增加约50%。与仅PAD相比,PAD/MVD与较大截肢风险相关(比值比[OR],1.30[95%CI,1.28-1.32]),轻微截肢(或,2.15[95%CI,2.12-2.18]),主要不良心脏事件(OR,1.04[95%CI,1.03-1.04]),住院死亡率(或,1.07[95%CI,1.05-1.09]),和再入院(危险比,1.02[95%CI,1.02-1.02])调整基线因素后。
结论:合并MVD存在于越来越多的PAD患者中,并与不良结局风险增加相关。需要进一步的前瞻性研究来了解这一弱势群体。
BACKGROUND: Peripheral artery disease (PAD) and microvascular disease (MVD) are highly prevalent conditions that share common risk factors. This observational study aimed to characterize patients with both conditions and determine the impact of comorbid PAD/MVD on outcomes.
RESULTS: Patients admitted across 31 states January 2011 through December 2018 with a primary or secondary diagnosis of PAD or MVD were included from the National Readmissions Database and weighted to approximate a national sample. Those age <18 years or with nonatherosclerotic leg injuries were excluded. Patients were divided into 3 groups: PAD-only, MVD-only, or comorbid PAD/MVD. Multiple logistic regression was used to evaluate associations with major and minor
amputations, major adverse cardiac events, and in-hospital mortality. Cox regression was used to evaluate associations with readmission within 1 year. The PAD group was used as reference. The final cohort included 33 972 772 admissions: 9.1 million with PAD, 21.3 million with MVD, and 3.6 million with both. Annual admissions for PAD/MVD increased to >500 000 in 2018. Major and minor
amputations increased ≈50% for PAD/MVD between 2011 and 2018. Compared with PAD-only, PAD/MVD was associated with a higher risk for major amputation (odds ratio [OR], 1.30 [95% CI, 1.28-1.32]), minor amputation (OR, 2.15 [95% CI, 2.12-2.18]), major adverse cardiac events (OR, 1.04 [95% CI, 1.03-1.04]), in-hospital mortality (OR, 1.07 [95% CI, 1.05-1.09]), and readmission (hazard ratio, 1.02 [95% CI, 1.02-1.02]) after adjustment for baseline factors.
CONCLUSIONS: Comorbid MVD is present in a large and growing number of patients with PAD and is associated with augmented risk for adverse outcomes. Further prospective research is merited to understand this vulnerable population.