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Int J Angiol 2012; 21(01): 035-040
DOI: 10.1055/s-0032-1302437
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Age, Male Gender, and Atrial Fibrillation Predict Lower Extremity Amputation or Revascularization in Patients with Peripheral Artery Diseases: A Population-Based Investigation

Jien-Jiun Chen   *
1   Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan
,
Lian-Yu Lin   *
2   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
,
Chang-Hsing Lee   *
3   Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
4   Department of Occupational Medicine, Ton Yen General Hospital, Hisn-Chu County, Taiwan
,
Chiau-Suong Liau
5   Cardiovascular Center, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, and Department of Internal Medicine, Tzu Chi University, Hualien, Taiwan
› Author Affiliations
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Publication History

Publication Date:
21 February 2012 (online)

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Abstract

By using the National Health Insurance (NHI) claim data of Taiwan, we sought to determine the predictors for nontraumatic lower extremity amputation (LEA) or peripheral revascularization procedures (PRP) in patients with peripheral artery disease (PAD). From the NHI claim data, we identified 12,206 patients with newly diagnosed PAD between 1998 and 2008, and followed them up to 2008. We explored the age, gender, and whether the patients had concomitant comorbid conditions, such as diabetes mellitus (DM), hypertension (HTN), atrial fibrillation (AF), stroke, hospitalization for coronary artery disease (CAD), myocardial infarction (MI), or heart failure (HF), and whether they were taking cilostazol at the time of recruitment. We searched for clinical parameters that might be important determinants for LEA or PRP in the study population. Of the 12,206 patients, 150 (1.2%) were found to undergo either LEA or PRP or both (LEA 81, PRP 53, both PRP and LEA 16). Old age, male gender, and history of hospitalization for CAD or MI and AF were found to be risk predictors for both procedures. Patients with DM were at lower risk for PRP (odds ratio 0.418, p = 0.001). Patients who were taking cilostazol had higher risk for LEA or PRP. HTN was not a risk predictor for LEA or PRP. From this nationwide study, we found that among PAD patients in Taiwan, age, male gender, AF, and hospitalization for CAD or MI are risk predictors for future LEA or PRP. DM is a negative predictor for PRP while both DM and HTN are not risk predictors for LEA.

Keywords

peripheral artery disease - lower extremity amputation - peripheral revascularization procedure - atrial fibrillation

* These authors contributed equally to this work


 

  • References

  • 1 Ross R. The pathogenesis of atherosclerosis—an update. N Engl J Med 1986; 314 (8) 488-500
    CrossrefPubMedGoogle Scholar
  • 2 Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001; 344 (21) 1608-1621
    CrossrefPubMedGoogle Scholar
  • 3 Fowkes FG, Housley E, Riemersma RA , et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 1992; 135 (4) 331-340
    PubMedGoogle Scholar
  • 4 American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26 (12) 3333-3341
    CrossrefPubMedGoogle Scholar
  • 5 Kudo T, Chandra FA, Ahn SS. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg 2005; 41 (3) 423-435 , discussion 435
    CrossrefPubMedGoogle Scholar
  • 6 Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol 2006; 47 (5) 921-929
    Google Scholar
  • 7 Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA 2006; 295 (5) 547-553
    CrossrefPubMedGoogle Scholar
  • 8 Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care 2001; 24 (8) 1433-1437
    CrossrefPubMedGoogle Scholar
  • 9 Calle-Pascual AL, Redondo MJ, Ballesteros M , et al. Nontraumatic lower extremity amputations in diabetic and non-diabetic subjects in Madrid, Spain. Diabetes Metab 1997; 23 (6) 519-523
    PubMedGoogle Scholar
  • 10 Trautner C, Haastert B, Giani G, Berger M. Amputations and diabetes: a case-control study. Diabet Med 2002; 19 (1) 35-40
    CrossrefPubMedGoogle Scholar
  • 11 Lu JF, Hsiao WC. Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood) 2003; 22 (3) 77-88
    PubMedGoogle Scholar
  • 12 Chiang TL. Taiwan's 1995 health care reform. Health Policy 1997; 39 (3) 225-239
    CrossrefPubMedGoogle Scholar
  • 13 Tseng CH. Mortality and causes of death in a national sample of diabetic patients in Taiwan. Diabetes Care 2004; 27 (7) 1605-1609
    CrossrefPubMedGoogle Scholar
  • 14 Chen HF, Ho CA, Li CY. Age and sex may significantly interact with diabetes on the risks of lower-extremity amputation and peripheral revascularization procedures: evidence from a cohort of a half-million diabetic patients. Diabetes Care 2006; 29 (11) 2409-2414
    CrossrefPubMedGoogle Scholar
  • 15 Garcia LA. Epidemiology and pathophysiology of lower extremity peripheral arterial disease. J Endovasc Ther 2006; 13 (Suppl 2) II3-II9
    PubMedGoogle Scholar
  • 16 Guzman RJ, Brinkley DM, Schumacher PM, Donahue RM, Beavers H, Qin X. Tibial artery calcification as a marker of amputation risk in patients with peripheral arterial disease. J Am Coll Cardiol 2008; 51 (20) 1967-1974
    CrossrefPubMedGoogle Scholar
  • 17 Ryder KM, Benjamin EJ. Epidemiology and significance of atrial fibrillation. Am J Cardiol 1999; 84 (9A) 131R-138R
    CrossrefPubMedGoogle Scholar
  • 18 Lee TT, Cheng SH, Chen CC, Lai MS. A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment. Am J Manag Care 2010; 16 (1) 65-69
    PubMedGoogle Scholar
  • 19 Creager MA. Medical management of peripheral arterial disease. Cardiol Rev 2001; 9 (4) 238-245
    CrossrefPubMedGoogle Scholar
  • 20 Igawa T, Tani T, Chijiwa T , et al. Potentiation of anti-platelet aggregating activity of cilostazol with vascular endothelial cells. Thromb Res 1990; 57 (4) 617-623
    CrossrefPubMedGoogle Scholar
  • 21. Kohda N, Tani T, Nakayama S , et al. Effect of cilostazol, a phosphodiesterase III inhibitor, on experimental thrombosis in the porcine carotid artery. Thromb Res 1999; 96 (4) 261-268
    CrossrefPubMedGoogle Scholar
  • 22 Robless P, Mikhailidis DP, Stansby GP. Cilostazol for peripheral arterial disease. Cochrane Database Syst Rev 2008; (1) CD003748
    PubMedGoogle Scholar
  • 23 Regensteiner JG, Ware Jr JE, McCarthy WJ , et al. Effect of cilostazol on treadmill walking, community-based walking ability, and health-related quality of life in patients with intermittent claudication due to peripheral arterial disease: meta-analysis of six randomized controlled trials. J Am Geriatr Soc 2002; 50 (12) 1939-1946
    CrossrefPubMedGoogle Scholar
  • 24 Tsuchikane E, Fukuhara A, Kobayashi T , et al. Impact of cilostazol on restenosis after percutaneous coronary balloon angioplasty. Circulation 1999; 100 (1) 21-26
    CrossrefPubMedGoogle Scholar
  • 25 Douglas Jr JS, Holmes Jr DR, Kereiakes DJ , et al; Cilostazol for Restenosis Trial (CREST) Investigators. Coronary stent restenosis in patients treated with cilostazol. Circulation 2005; 112 (18) 2826-2832
    CrossrefPubMedGoogle Scholar
  • 26 Iida O, Nanto S, Uematsu M , et al. Cilostazol reduces target lesion revascularization after percutaneous transluminal angioplasty in the femoropopliteal artery. Circ J 2005; 69 (10) 1256-1259
    CrossrefPubMedGoogle Scholar
  • 27 Assaf AR, Lapane KL, McKenney JL, Carleton RA. Possible influence of the prospective payment system on the assignment of discharge diagnoses for coronary heart disease. N Engl J Med 1993; 329 (13) 931-935
    CrossrefPubMedGoogle Scholar