Immediate results and long-term cardiovascular outcomes of endovascular therapy in octogenarians and nonoctogenarians with peripheral arterial diseases

Figures & data

Figure 1 Flowchart of study participants.

Abbreviations: ALI, acute limb ischemia; PAD, peripheral artery disease.

Table 1 Baseline demographics

	Octogenarians	Nonoctogenarians	P-value
No of patients	136	375
Age (years)	85±4	66±9	<0.001*
Male sex	65 (48)	218 (58)	0.038*
Underlying disease
Diabetes mellitus	77 (57)	317 (85)	<0.001*
Hypertension	112 (82)	319 (85)	0.456
CAD	54 (40)	186 (50)	0.047*
CVD	35 (26)	79 (21)	0.252
ESRD	30 (22)	169 (45)	<0.001*
CHF	23 (17)	65 (17)	0.614
Smoking	38 (28)	149 (40)	0.014*
Hyperlipidemia	48 (35)	194 (52)	0.001*
Atrial fibrillation	35 (26)	43 (11)	<0.001*
Body height (m)	1.57±0.09	1.60±0.08	<0.001*
Body weight (kg)	57±11	62±10	<0.001*
BMI (kg/m^2)	23.1±3.5	24.2±3.3	<0.001*
Hematocrit (mg/dL)	33.8±4.9	34.0±5.9	0.645
CRP (mg/dL)	3.19±4.94	5.13±6.96	<0.001*
NLR	4.32±4.48	5.46±8.58	0.120
PLR	183±235	190±137	0.618
HbA1C (%)	6.5±1.4	7.6±1.9	<0.001*
LDL-C (mg/dL)	93±30	98±35	0.063
Albumin (mg/dL)	3.19±0.61	3.15±0.67	0.183
Medications
Aspirin	70 (51)	213 (57)	0.284
Thienopyridine	109 (80)	305 (81)	0.762
Cilostazole	103 (76)	281 (75)	0.383
Statin	29 (21)	137 (37)	0.001*
Beta-blocker	47 (35)	148 (39)	0.313
ACEI or ARB	68 (50)	186 (50)	0.936

Notes:

Values are mean ± SD or n (%);

* P<0.05 indicates a significant difference between groups.

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BMI, body mass index; CAD, coronary artery disease; CHF, congestive heart failure; CRP, C-reactive protein; CVD, cerebrovascular disease; ESRD, end-stage renal disease; HbA1C, glycated hemoglobin; LDL-C, low-density lipoprotein cholesterol; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SD, standard deviation.

Table 2 Characteristics of the affected limb

	Octogenarians	Nonoctogenarians	P-value
No of affected limbs	170	484
Target-limb ABI	0.46±0.17	0.51±0.20	0.002*
Stiff artery	24 (14%)	71 (15%)	0.861
Clinical presentation
Intermittent claudication	20 (12%)	97 (20%)	0.008*
Rest pain	44 (26%)	86 (18%)	0.022*
Nonhealing ulcer	79 (46%)	219 (45%)	0.783
Gangrene	27 (16%)	82 (17%)	0.458
Procedure success	175 (94%)	503 (95%)	0.557
Single level	83 (49%)	272 (56%)	0.096
Iliac	12	55	0.111
FP	36	95	0.664
BTK	35	122	0.225
Multilevel	87 (51%)	212 (44%)	0.096
Iliac + FP	7	13	0.351
FP + BTK	79	192	0.121
Ilio-FP-BTK	1	7	0.381
Iliac and BTK	0	2	0.401
Stenting rate	99 (58%)	272 (56%)	0.645

Notes: Values are mean ± SD or n (%);

* P<0.05 indicates a significant difference between groups.

Abbreviations: ABI, ankle brachial index; FP, femoropopliteal; BTK, below-the-knee; SD, standard deviation.

Table 3 Thirty-day outcomes and changes in functional status after EVT

		Octogenarians	Nonoctogenarians	P-value
No of affected limbs		170	484
Death		3	7	0.771
MI		2	6	0.949
CVA		2	3	0.609
Emergent surgery		0	2	0.401
AKI requiring dialysis		0	3	0.304
Groin complications		10	24	0.641
Subacute arterial occlusion		2	1	0.107
Unplanned reintervention		0	3	0.304
UGI bleeding with shock		1	0	0.553
Compartment syndrome		1	1	0.438
Length of stay (days)		8±8	11±12	0.002*
Number of ICU transfers		15 (8.8%)	46 (9.5%)	0.792
MAVE		21 (12.4%)	50 (10.3%)	0.466
Changes in functional status after EVT		Octogenarians N=115	Nonoctogenarians N=333	P-value 0.24
	Admission	6 months	Admission	6 months
AI	2 (2%)	42 (37%)	42 (13%)	193 (58%)
AA	23 (20%)	37 (32%)	161 (36%)	75 (23%)
WH	79 (68%)	31 (27%)	121 (48%)	60 (18%)
BED	11 (10%)	5 (4%)	9 (3%)	5 (2%)

Notes: Values are mean ± SD or n (%);

* P<0.05 indicates a significant difference between groups.

Abbreviations: EVT, endovascular therapy; AI, ambulatory independently; AA, ambulatory with assisting device; BED, bed-ridden status; CVA, cerebrovascular accident; MI, myocardial infarction; AKI, acute kidney injury; UGI, upper gastrointestinal; ICU, intensive care unit; MAVE, major adverse vascular event; WH, wheelchair-bound; SD, standard deviation.

Table 4 Crude and significant multivariate risk factors for long-term events

Outcome predictors	OR (95% CI)	P-value
Overall survival
Atrial fibrillation	2.83 (1.49–5.35)	0.001
Dialysis dependence	4.44 (1.79–11.1)	0.001
Critical limb ischemia	3.19 (1.31–7.74)	0.001
Major cerebrovascular and cardiovascular events
Atrial fibrillation	2.45 (1.31–4.45)	0.005
Dialysis dependence	3.49 (1.48–8.19)	0.004
Coronary artery disease	1.74 (1.13–2.66)	0.011
C-reactive protein	1.05 (1.01–1.09)	0.019
Composite vascular events
Atrial fibrillation	2.25 (1.21–4.17)	0.010
Dialysis dependence	3.14 (1.32–7.48)	0.009
Coronary artery disease	1.84 (1.18–2.86)	0.007

Abbreviations: OR, odds ratio; CI, confidence interval.

Figure 2 Kaplan–Meier curves for overall survival.

Notes: The survival rates for octogenarians and nonoctogenarians were 63% and 73% at 3 years and 45% and 67% at 5 years, respectively (P=0.004). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.

Figure 3 Kaplan–Meier curves for freedom from major cerebrovascular and cardiovascular events (MACCEs).

Notes: The rates of 3-year freedom from MACCEs were similar between groups (50% in octogenarians vs 55% in nonoctogenarians, P=0.564). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.

Figure 4 Kaplan–Meier curves for freedom from composite vascular events (CVEs).

Notes: The rates of 3-year freedom from CVEs were similar between groups (63% in octogenarians vs 61% in nonoctogenarians, P=0.308). Yellow line and blue line represent octogenarians and nonoctogenarians, respectively.