■有症状的下肢外周动脉疾病(PAD)的血管内治疗(EVT)是有效且微创的。然而,PAD患者往往有较高的出血风险(HBR),关于EVT后PAD患者的HBR数据有限。在这项研究中,我们调查了HBR的患病率和严重程度,以及其与接受EVT的PAD患者临床结局的关系。
■将高出血风险学术研究联盟(ARC-HBR)标准应用于732例连续的下肢PAD患者EVT后,以评估HBR的患病率,及其与大出血事件的关系,全因死亡率,和缺血事件。获得ARC-HBR评分(每个主要标准1分,每个次要标准0.5分),并将患者分为四组(评分:0-0.5;低风险,评分:1-1.5;中等风险,分数:2-2.5;高风险,和分数:≥3;非常高风险)根据分数。主要出血事件定义为出血学术研究联盟3型或5型出血,缺血事件被定义为心肌梗死的复合事件,缺血性卒中,2年内出现急性肢体缺血。
■78.8%的患者发生高出血风险。大出血事件,全因死亡率,缺血性事件发生率为9.7%,18.7%,和6.4%的研究队列,分别,在2年内。在后续期间,主要出血事件随ARC-HBR评分显著增加.ARC-HBR评分的严重程度与大出血事件的风险增加显着相关(高风险:调整后的风险比[HR]5.62;95%置信区间[CI]:[1.28,24.62];p=0.022;非常高风险:调整后的HR:10.37;95%CI:[2.32,46.30];p=0.002)。全因死亡率和缺血事件也随着ARC-HBR评分的升高而显著增加。
■下肢PAD的高出血风险患者可能存在出血事件的高风险,死亡率,和EVT后的缺血事件。ARC-HBR标准及其相关评分可以成功地对HBR患者进行分层,并评估接受EVT的下肢PAD患者的出血风险。
结论:有症状的下肢外周动脉疾病(PAD)的血管内治疗(EVT)是有效和微创的。然而,PAD患者往往有较高的出血风险(HBR),关于EVT后PAD患者的HBR数据有限。后EVT,根据学术研究联盟HBR(ARC-HBR)标准,大多数PAD患者被归类为HBR,在这项包含732名参与者的回顾性研究中,随着ARC-HBR评分的增加,2年内出血事件以及死亡率和缺血事件的发生率也随之增加.患有PAD的HBR患者在中期不仅有出血事件的高风险,而且有死亡和缺血事件的高风险。ARC-HBR标准及其相关评分可以成功地对HBR患者进行分层,并评估接受EVT的PAD患者的出血风险。
UNASSIGNED: Endovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. In this study, we investigated the prevalence and severity of HBR, as well as its association with clinical outcomes in the patients with PAD who underwent EVT.
UNASSIGNED: The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were applied to 732 consecutive patients with lower extremity PAD post-EVT to assess the prevalence of HBR, and its association with major bleeding events, all-cause mortality, and ischemic events. The ARC-HBR scores (1 point for each major criterion and 0.5 points for each minor criterion) were obtained and the patients were divided into four groups (score: 0-0.5; low risk, score: 1-1.5; moderate risk, score: 2-2.5; high risk, and score: ≥3; very high risk) according to the score. Major bleeding events were defined as Bleeding Academic Research Consortium type-3 or type-5 bleeding, and ischemic events were defined as the composite of myocardial infarction, ischemic stroke, and acute limb ischemia within 2 years.
UNASSIGNED: High bleeding risk occurred in 78.8% of the patients. Major bleeding events, all-cause mortality, and ischemic events occurred in 9.7%, 18.7%, and 6.4% of the study cohort, respectively, within 2 years. During the follow-up period, major bleeding events significantly increased with the ARC-HBR score. The severity of the ARC-HBR score was significantly associated with an increased risk of major bleeding events (high risk: adjusted hazard ratio [HR] 5.62; 95% confidence interval [CI]: [1.28, 24.62]; p=0.022; very high risk: adjusted HR: 10.37; 95% CI: [2.32, 46.30]; p=0.002). All-cause mortality and ischemic events also significantly increased with higher ARC-HBR score.
UNASSIGNED: High bleeding risk patients with lower extremity PAD can be at a high risk of bleeding events, mortality, and ischemic events after EVT. The ARC-HBR criteria and its associated scores can successfully stratify HBR patients and assess the bleeding risk in patients with lower extremity PAD who undergo EVT.
CONCLUSIONS: Endovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. Post EVT, most of the patients with PAD were classified as having HBR using the Academic Research Consortium for HBR (ARC-HBR) criteria and the rate of bleeding events as well as mortality and ischemic events within 2 years increased as the ARC-HBR score increased in this retrospective study of 732 participants. HBR patients with PAD can be at high risk of not only bleeding events but also mortality and ischemic events in the mid-term. The ARC-HBR criteria and its associated scores can successfully stratify HBR patients and assess the bleeding risk in patients with PAD who underwent EVT.