Impact Of Peripheral Vascular Disease Research Articles

Impact of Peripheral Vascular Disease on In-Hospital Outcomes After Percutaneous Coronary Intervention

Impact of Peripheral Vascular Disease on In-Hospital Outcomes After Percutaneous Coronary Intervention

Cerebrovascular Disease Hospitalization Rates in End-Stage Kidney Disease Patients with Kidney Transplant and Peripheral Vascular Disease: Analysis Using the National Inpatient Sample (2005-2019).

Individuals with end-stage kidney disease (ESKD) face higher cerebrovascular risk. Yet, the impact of peripheral vascular disease (PVD) and kidney transplantation (KTx) on hospitalization rates for cerebral infarction and hemorrhage remains underexplored. Analyzing 2,713,194 ESKD hospitalizations (2005-2019) using the National Inpatient Sample, we investigated hospitalization rates for ischemic and hemorrhagic cerebrovascular diseases concerning ESKD, PVD, KTx, or their combinations. Patients hospitalized with cerebral infarction due to thrombosis/embolism/occlusion (CITO) or artery occlusion resulting in cerebral ischemia (AOSI) had higher rates of comorbid ESKD and PVD (4.17% and 7.29%, respectively) versus non-CITO or AOSI hospitalizations (2.34%, p < 0.001; 2.29%, p < 0.001). Conversely, patients hospitalized with nontraumatic intracranial hemorrhage (NIH) had significantly lower rates of ESKD and PVD (1.64%) compared to non-NIH hospitalizations (2.34%, p < 0.001). Furthermore, hospitalizations for CITO or AOSI exhibited higher rates of KTx and PVD (0.17%, 0.09%, respectively) compared to non-CITO or AOSI hospitalizations (0.05%, p = 0.033; 0.05%, p = 0.002). Patients hospitalized with NIH showed similar rates of KTx and PVD (0.04%) versus non-NIH hospitalizations (0.05%, p = 0.34). This nationwide analysis reveals that PVD in ESKD patients is associated with increased hospitalization rates with cerebral ischemic events and reduced NIH events. Among KTx recipients, PVD correlated with increased hospitalizations for ischemic events, without affecting NIH. This highlights management concerns for patients with KTx and PVD.

Abstract 16971: Unraveling the Burden of Cerebrovascular Disease: Exploring the Role of Peripheral Vascular Disease and Kidney Transplant in End-Stage Renal Disease Hospitalization Rates (Insights From the National Inpatient Sample, 2005 to 2019)

Background: Patients with end-stage renal disease (ESRD) face a higher risk of cerebrovascular disease, but the impact of peripheral vascular disease (PVD) and a kidney transplant (KiTx) on hospitalization rates for cerebrovascular conditions remains uncertain. This study aimed to investigate the rates of hospitalization for cerebrovascular disease in patients with ESRD, PVD, KiTx, or a combination. Methods: Using the National Inpatient Sample (NIS), 2,713,194 ESRD hospitalizations (2005-2019) were analyzed. We focused on two cerebrovascular conditions of interest: 1) cerebral infarction due to thrombosis, embolism, and occlusion (CITO) and 2) artery occlusion resulting in cerebral ischemia (AOSI). Comparative analysis utilized t-tests and odds ratios. Results: Among ESRD hospitalizations, 66,927 (2.47%) had KiTx, 63,411 (2.34%) had PVD, and 1,406 (0.05%) had both. Key findings included: 1) ESRD patients with PVD had higher odds of hospitalization for CITO (OR 1.33, CI 1.1-1.8, p=0.009) or AOSI (OR 2.63, CI 2.5-2.8, p&lt;0.001) compared to those without PVD (Fig. 1AB); 2) ESRD patients hospitalized with CITO had higher odds of having KiTx and PVD compared to those without KiTx or PVD (OR 3.17, CI 1.0-9.3, p=0.035, Fig. 1AB); 3) ESRD patients with PVD had higher rates of being hospitalized with AOSI (7.29%) than those without AOSI (2.29%, p&lt;0.001); 4) ESRD patients hospitalized with CITO had higher odds of having KiTx and PVD compared to those without KiTx or PVD (OR 3.17, CI 1.0-9.3, p=0.035, Fig. 1AB) and 5) ESRD patients hospitalized with AOSI demonstrated a higher rate of having KiTx and PVD (0.09%) compared to those without AOSI (0.05%, p=0.002). Conclusion: This nationwide analysis reveals that the presence of PVD and KiTx is associated with increased rates of hospitalization for cerebrovascular conditions. These findings underscore the importance of proactive management to mitigate the risk of cerebrovascular disease in this vulnerable patient population.

Nationwide analysis on the impact of peripheral vascular disease following primary total knee arthroplasty: A matched-control analysis

BackgroundAs the prevalence of peripheral vascular disease (PVD) continues to increase nationwide, studies demonstrating its effects following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study was to evaluate whether patients with PVD have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) medical complications; 4) implant-related complications; and 5) costs of care. MethodsUsing a nationwide database, patients with PVD undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 1,547,092 between the cohorts. Outcomes analyzed included: in-hospital LOS, readmission rates, complications, and costs of care. A p-value less than 0.004 was considered statistically significant. ResultsPVD patients had significantly longer in-hospital LOS (4-days vs. 3-days, p < 0.0001). Additionally, the study cohort had a higher incidence and odds (OR) of readmissions (20.5 vs. 15.2%; OR: 1.43, 95% CI: 1.42–1.45, p < 0.0001), medical complications (2.46 vs. 1.32%; OR: 1.88, CI: 1.83–1.94, p < 0.0001), and implant-related complications (3.82 vs. 2.18%; OR: 1.78, CI: 1.26–1.58, p < 0.0001). Additionally, the study found patients with PVD had higher day of surgery (p < 0.0001) and 90-day costs of care (p < 0.0001). ConclusionsAfter adjusting for confounding variables the results of the study show patients with PVD undergoing primary TKA have longer in-hospital LOS; in addition to higher rates of complications, readmissions, and costs of care. The study can be utilized by orthopaedists to adequately counsel patients of the potential complications following their procedure.

Impact of Peripheral Vascular Disease on Short-Term In-Hospital Outcomes for Patients with Traumatic Brain Injury

Peripheral vascular disease (PVD) is associated with impaired neurocognitive recovery in acute traumatic brain injury (TBI) patients. There is sparse amount of literature reporting the impact of PVD on outcomes in this population. This study aims to further investigate the common comorbidity of PVD and its effects on the outcomes of short-term in-hospital patients after acute TBI.

IMPACT OF PERIPHERAL VASCULAR DISEASE AND RACE ON OUTCOMES IN PATIENTS WITH CARDIAC ARREST

Peripheral Vascular Disease(PVD) is an independent predictor of elevated risk of myocardial infarction, stroke and death. However, no prior studies have looked into the impact of PVD on outcomes of patients with cardiac arrest. The aim of this study was to assess that if presence of PVD was an

Impact of Peripheral Vascular Disease on Mortality in Wait Listed Dialysis Patients and Recipients of a First Kidney Transplant.

Introduction: There is lack of information whether waitlisted dialysis patients with peripheral vascular disease (PVD) benefit from kidney transplantation. Methods: We used a cohort of USRDS incident dialysis patients from 2001 to 2007, with follow-up through 2008. Patients with PVD and under the age of 70 were included and divided into three groups; PVD patients on dialysis, waitlisted and PVD patients who received a first transplant (deceased or living). We calculated the mean comorbidity risk score (CRS) to determine differences in health status inpatients on dialysis, waitlist and at transplantation. CRS comprised of history of diabetes mellitus, hypertension, hypercholesterolemia, myocardial infarction, cerebrovascular disease and age greater than 55 years, by assigning a value of 1 to each comorbidity at the time first service. The primary outcome was all cause mortality. Standardized Mortality Ratios (SMR) and hazard ratios of death were calculated for statistical comparisons between the 3 groups. Results: 23,699 incident dialysis patients met inclusion criteria; only 16.7% (n=3964) were waitlisted, of which 8.9 % (n=2121) were transplanted. The annual death rates per 100 patient years was 22.86 in PVD patients on dialysis, 4.98 in waitlisted PVD patients and 4.86 in kidney transplant recipients. There was significant differences in mean co-morbidity risk score (2.38± 0.018 vs. 2.30 ±0.020 p=0.003) but not in adjusted hazard ratio 1.10 (95% CI 0.89-1.33, p=0.41) vs. 1.05 (95% CI 0.79-1.39, p=0.75) between waitlisted and transplanted patients with PVD. Figure 1 shows patient survival in PVD patients.Figure: No Caption available.Conclusions: There was no survival advantage of transplantation compared to remaining on the waitlist in PVD patients.

445 Increased Mortality Following Cardiac Transplantation in Patients with Peripheral Vascular Disease

There is paucity of data on the impact of peripheral vascular disease (PVD) in heart transplant candidates and severe PVD is a relative contraindication for heart transplantation. The mortality of patients with asymptomatic PVD following cardiac transplantation is not well known. We, therefore, analyzed the association between known PVD in patients with advanced heart failure and survival following cardiac transplantation.

Vascular disease as a predictor of long-term mortality in patients hospitalized for new-onset heart failure

Comorbidities have an adverse influence on the outcome of patients with heart failure (HF). We investigated the impact of peripheral vascular disease (PVD) on long-term mortality in hospitalized patients with HF. We included prospectively consecutive patients (N=799) hospitalized for a first episode of HF in all healthcare establishments within a single French department during 2000. Patients with peripheral arterial disease and/or history of stroke were considered to have PVD. Baseline characteristics and 5-year mortality were compared according to PVD status. PVD was diagnosed in 172 patients (22%) and clinical coronary artery disease in 302 patients (38%). Patients with PVD were older, predominantly men, smokers, and more often had diabetes and coronary artery disease. PVD was associated with an increased risk of crude 5-year overall mortality (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.35-2.03; P<0.001). After adjustment for covariates, the relationship remained significant (HR 1.33, 95% CI 1.08-1.65; P=0.008). Compared with the expected survival, the 5-year survival of the PVD group was dramatically lower (24% versus 67%). The risk of cardiovascular death was higher for PVD patients (HR 1.39, 95% CI 1.07-1.80; P=0.014). PVD probably modulates the impact of other covariates on outcome. PVD is a potent predictor of adverse outcome in patients with new-onset HF.

The Impact of Peripheral Vascular Disease on Long-Term Survival After Coronary Artery Bypass Graft Surgery

Although peripheral vascular disease is known to negatively affect overall survival, its effects on survival after surgical myocardial revascularization have not been well described. The objective of this study was to examine the impact of peripheral vascular disease on long-term survival after coronary artery bypass grafting. We reviewed records of 1,164 consecutive patients (370 with peripheral vascular disease and 794 without it) who underwent primary isolated coronary artery bypass graft surgery between 1997 and 2007. Univariate and multivariate logistic regression methods were used to analyze variables associated with early outcomes. We assessed long-term survival by using Kaplan-Meier curves generated by log-rank tests, adjusting for confounding factors with Cox proportional hazards regression analysis. Patients with peripheral vascular disease were generally sicker and had more comorbidities than patients without peripheral vascular disease. The presence of peripheral vascular disease does not predict increased rates of 30-day mortality or major adverse cardiac events. However, after controlling for potential confounding factors, patients with peripheral vascular disease had a significantly worse 9-year survival rate than patients without peripheral vascular disease (72.9% +/- 4.1% versus 82.8% +/- 2.4%; adjusted hazard ratio, 1.7; 95% confidence interval: 1.2 to 2.4; p = 0.004). Although peripheral vascular disease does not affect early outcomes in coronary artery bypass operations, it is an independent predictor of poor long-term survival among patients undergoing coronary artery bypass graft surgery. Identifying the mechanism that underlies this difference is important for improving survival in patients with peripheral vascular disease who undergo surgical myocardial revascularization.

Usefulness of the Presence of Peripheral Vascular Disease in Predicting Mortality in Acute Myocardial Infarction Patients Treated With Primary Angioplasty (from the Primary Angioplasty in Myocardial Infarction Database)

Patients with acute myocardial infarction (AMI) often have multiple co-morbidities that influence outcome. We sought to evaluate the impact of peripheral vascular disease (PVD) on the outcome of patients with AMI treated with primary angioplasty. We evaluated 3,716 patients with AMI who underwent emergency catheterization with planned primary angioplasty in the Primary Angioplasty in Myocardial Infarction trials. Patients with a history of PVD (claudication, stroke, or transient ischemic attack) were compared with patients without PVD. Of the 3,716 patients, 394 (10.6%) had PVD and were older, more often women, and more frequently had a history of diabetes mellitus, hypertension, smoking, congestive heart failure, angina, myocardial infarction, and coronary revascularization. They presented more often with a heart rate >100 beats/min, Killip class >1, lower ejection fraction, and multivessel disease. No difference was found in stent use, final percentage of stenosis, or Thrombolysis In Myocardial Infarction 3 flow. Patients with PVD had a twofold increased in-hospital mortality (5.3% vs 2.6%, p = 0.0021). The difference remained significant at 1 month, 6 months, and 1 year (12.6% vs 6%, p < 0.0001). In multivariate logistic regression analysis, a history of PVD was an independent predictor of in-hospital mortality and death at 1 year (odds ratio 1.64, 95% confidence interval 1.04 to 2.57, p = 0.032). In conclusion, patients with AMI with PVD have increased co-morbidities and higher mortality despite treatment with primary angioplasty. The presence of PVD is an independent predictor of in-hospital mortality and death at 1 year.

Impact of peripheral vascular disease on in-hospital outcomes following percutaneous coronary intervention

Impact of peripheral vascular disease on in-hospital outcomes following percutaneous coronary intervention

Socioeconomic impact of peripheral vascular disease

Socioeconomic impact of peripheral vascular disease