Long-term prognostic risk in lower extremity peripheral arterial disease as a function of the number of peripheral arterial lesions

K.G.E. Smolderen, M. van Zitteren, Philip G Jones, John A Spertus, Jan M Heyligers, Maria J Nooren, Patrick W Vriens, J. Denollet

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Abstract

Background: 

Although patients with peripheral artery disease (PAD) are known to have an increased risk of adverse prognosis, simple techniques to further risk-stratify PAD patients would be clinically useful. A plausible but unexplored factor to predict such risk would be greater disease burden, manifested as multiple lower extremity lesions. The aim of this study was to examine the association between having multiple versus isolated lower extremity PAD lesions and long-term prognosis.

Methods and results: 

A prospective cohort of 756 newly diagnosed PAD patients underwent duplex ultrasound testing to determine the number of lower extremity lesions. Cox regression models examined the independent association of lesion number (≥3 and 2 versus 1) and adverse prognosis (defined as a composite end point comprising first occurrence of either lower extremity amputation, admission for heart failure, nonfatal stroke, myocardial infarction, or unstable angina or mortality), adjusting for demographic and clinical risk factors. Analyses were replicated using an advanced Cox-based model for multiple events. A total of 173 patients (23%) had ≥3 lesions, 197 (26%) had 2 lesions, and 386 (51%) had 1 lesion. After a median follow-up of 3.2 years, patients with ≥3 lesions had an increased risk of experiencing a first adverse event (adjusted hazard ratio 1.60, 95% CI 1.08-2.38, P=0.020) and an increased risk of having multiple events (adjusted hazard ratio 1.53, 95% CI 1.08-2.18, P=0.018). Patients with 2 lesions had a prognosis similar to those with 1 lesion.

Conclusions: 

Among PAD patients, a greater number of lesions is associated with an increased risk of an adverse prognosis over 3 years of follow-up. Assessing the number of lower extremity lesions might serve as a simple risk-stratification tool at initial PAD diagnosis.

Original languageEnglish
Article numbere001823
JournalJournal of the American Heart Association
Volume4
Issue number10
DOIs
Publication statusPublished - 2015

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Smolderen, K.G.E. ; van Zitteren, M. ; Jones, Philip G ; Spertus, John A ; Heyligers, Jan M ; Nooren, Maria J ; Vriens, Patrick W ; Denollet, J. / Long-term prognostic risk in lower extremity peripheral arterial disease as a function of the number of peripheral arterial lesions. In: Journal of the American Heart Association. 2015 ; Vol. 4, No. 10.
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title = "Long-term prognostic risk in lower extremity peripheral arterial disease as a function of the number of peripheral arterial lesions",
abstract = "Background: Although patients with peripheral artery disease (PAD) are known to have an increased risk of adverse prognosis, simple techniques to further risk-stratify PAD patients would be clinically useful. A plausible but unexplored factor to predict such risk would be greater disease burden, manifested as multiple lower extremity lesions. The aim of this study was to examine the association between having multiple versus isolated lower extremity PAD lesions and long-term prognosis.Methods and results: A prospective cohort of 756 newly diagnosed PAD patients underwent duplex ultrasound testing to determine the number of lower extremity lesions. Cox regression models examined the independent association of lesion number (≥3 and 2 versus 1) and adverse prognosis (defined as a composite end point comprising first occurrence of either lower extremity amputation, admission for heart failure, nonfatal stroke, myocardial infarction, or unstable angina or mortality), adjusting for demographic and clinical risk factors. Analyses were replicated using an advanced Cox-based model for multiple events. A total of 173 patients (23{\%}) had ≥3 lesions, 197 (26{\%}) had 2 lesions, and 386 (51{\%}) had 1 lesion. After a median follow-up of 3.2 years, patients with ≥3 lesions had an increased risk of experiencing a first adverse event (adjusted hazard ratio 1.60, 95{\%} CI 1.08-2.38, P=0.020) and an increased risk of having multiple events (adjusted hazard ratio 1.53, 95{\%} CI 1.08-2.18, P=0.018). Patients with 2 lesions had a prognosis similar to those with 1 lesion.Conclusions: Among PAD patients, a greater number of lesions is associated with an increased risk of an adverse prognosis over 3 years of follow-up. Assessing the number of lower extremity lesions might serve as a simple risk-stratification tool at initial PAD diagnosis.",
author = "K.G.E. Smolderen and {van Zitteren}, M. and Jones, {Philip G} and Spertus, {John A} and Heyligers, {Jan M} and Nooren, {Maria J} and Vriens, {Patrick W} and J. Denollet",
note = "{\circledC} 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.",
year = "2015",
doi = "10.1161/JAHA.115.001823",
language = "English",
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journal = "Journal of the American Heart Association",
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Long-term prognostic risk in lower extremity peripheral arterial disease as a function of the number of peripheral arterial lesions. / Smolderen, K.G.E.; van Zitteren, M.; Jones, Philip G; Spertus, John A; Heyligers, Jan M; Nooren, Maria J; Vriens, Patrick W; Denollet, J.

In: Journal of the American Heart Association, Vol. 4, No. 10, e001823, 2015.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Long-term prognostic risk in lower extremity peripheral arterial disease as a function of the number of peripheral arterial lesions

AU - Smolderen, K.G.E.

AU - van Zitteren, M.

AU - Jones, Philip G

AU - Spertus, John A

AU - Heyligers, Jan M

AU - Nooren, Maria J

AU - Vriens, Patrick W

AU - Denollet, J.

N1 - © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

PY - 2015

Y1 - 2015

N2 - Background: Although patients with peripheral artery disease (PAD) are known to have an increased risk of adverse prognosis, simple techniques to further risk-stratify PAD patients would be clinically useful. A plausible but unexplored factor to predict such risk would be greater disease burden, manifested as multiple lower extremity lesions. The aim of this study was to examine the association between having multiple versus isolated lower extremity PAD lesions and long-term prognosis.Methods and results: A prospective cohort of 756 newly diagnosed PAD patients underwent duplex ultrasound testing to determine the number of lower extremity lesions. Cox regression models examined the independent association of lesion number (≥3 and 2 versus 1) and adverse prognosis (defined as a composite end point comprising first occurrence of either lower extremity amputation, admission for heart failure, nonfatal stroke, myocardial infarction, or unstable angina or mortality), adjusting for demographic and clinical risk factors. Analyses were replicated using an advanced Cox-based model for multiple events. A total of 173 patients (23%) had ≥3 lesions, 197 (26%) had 2 lesions, and 386 (51%) had 1 lesion. After a median follow-up of 3.2 years, patients with ≥3 lesions had an increased risk of experiencing a first adverse event (adjusted hazard ratio 1.60, 95% CI 1.08-2.38, P=0.020) and an increased risk of having multiple events (adjusted hazard ratio 1.53, 95% CI 1.08-2.18, P=0.018). Patients with 2 lesions had a prognosis similar to those with 1 lesion.Conclusions: Among PAD patients, a greater number of lesions is associated with an increased risk of an adverse prognosis over 3 years of follow-up. Assessing the number of lower extremity lesions might serve as a simple risk-stratification tool at initial PAD diagnosis.

AB - Background: Although patients with peripheral artery disease (PAD) are known to have an increased risk of adverse prognosis, simple techniques to further risk-stratify PAD patients would be clinically useful. A plausible but unexplored factor to predict such risk would be greater disease burden, manifested as multiple lower extremity lesions. The aim of this study was to examine the association between having multiple versus isolated lower extremity PAD lesions and long-term prognosis.Methods and results: A prospective cohort of 756 newly diagnosed PAD patients underwent duplex ultrasound testing to determine the number of lower extremity lesions. Cox regression models examined the independent association of lesion number (≥3 and 2 versus 1) and adverse prognosis (defined as a composite end point comprising first occurrence of either lower extremity amputation, admission for heart failure, nonfatal stroke, myocardial infarction, or unstable angina or mortality), adjusting for demographic and clinical risk factors. Analyses were replicated using an advanced Cox-based model for multiple events. A total of 173 patients (23%) had ≥3 lesions, 197 (26%) had 2 lesions, and 386 (51%) had 1 lesion. After a median follow-up of 3.2 years, patients with ≥3 lesions had an increased risk of experiencing a first adverse event (adjusted hazard ratio 1.60, 95% CI 1.08-2.38, P=0.020) and an increased risk of having multiple events (adjusted hazard ratio 1.53, 95% CI 1.08-2.18, P=0.018). Patients with 2 lesions had a prognosis similar to those with 1 lesion.Conclusions: Among PAD patients, a greater number of lesions is associated with an increased risk of an adverse prognosis over 3 years of follow-up. Assessing the number of lower extremity lesions might serve as a simple risk-stratification tool at initial PAD diagnosis.

U2 - 10.1161/JAHA.115.001823

DO - 10.1161/JAHA.115.001823

M3 - Article

VL - 4

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 10

M1 - e001823

ER -