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Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial.

Publication ,  Journal Article
Baumgartner, I; Norgren, L; Fowkes, FGR; Mulder, H; Patel, MR; Berger, JS; Jones, WS; Rockhold, FW; Katona, BG; Mahaffey, K; Hiatt, WR ...
Published in: J Am Coll Cardiol
October 2, 2018

BACKGROUND: Lower extremity revascularization (LER) is a common treatment in patients with peripheral artery disease (PAD), but long-term outcomes are poorly defined. OBJECTIVES: The aim was to analyze LER in the EUCLID (Examining Use of tiCagreLor In paD) trial to determine predictors and cardiovascular outcomes. METHODS: Patients were grouped according to whether they received a post-randomization LER (n = 1,738) or not (n = 12,147). All variables were assessed for significance in univariable and parsimonious multivariable models. The primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death; major adverse limb events (MALE) included acute limb ischemia or major amputation. RESULTS: A post-randomization LER occurred in 12.5% of patients and was an endovascular LER in 74.7%. Endovascular LERs were performed more often in North America, whereas surgical procedures occurred more frequently in Europe. Independent factors predicting LER were prior and type of prior LER, geographic region, limb symptoms, diabetes, and smoking. A post-randomization LER was associated with an increased risk for the primary endpoint (hazard ratio: 1.60; 95% confidence interval: 1.35 to 1.90; p < 0.0001) and MALE (hazard ratio: 12.0; 95% confidence interval: 9.47 to 15.30; p < 0.0001). Event rates for the primary endpoint after LER were numerically higher in the surgical subgroup, but MALE were similar between surgical and endovascular LER. CONCLUSIONS: In the EUCLID trial, LER was most often endovascular. Following LER, there was an increased hazard for the primary endpoint (with higher event rates in the surgical group) and a markedly increased risk for MALE events (with similar event rates between surgical and endovascular LER procedures). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 2, 2018

Volume

72

Issue

14

Start / End Page

1563 / 1572

Location

United States

Related Subject Headings

  • Stroke
  • Popliteal Artery
  • Peripheral Arterial Disease
  • Myocardial Infarction
  • Male
  • Lower Extremity
  • Ischemia
  • Humans
  • Hemorrhage
  • Femoral Artery
 

Citation

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Baumgartner, I., Norgren, L., Fowkes, F. G. R., Mulder, H., Patel, M. R., Berger, J. S., … Executive Committee and Investigators of the EUCLID Trial, . (2018). Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial. J Am Coll Cardiol, 72(14), 1563–1572. https://doi.org/10.1016/j.jacc.2018.07.046
Baumgartner, Iris, Lars Norgren, F Gerry R. Fowkes, Hillary Mulder, Manesh R. Patel, Jeffrey S. Berger, W Schuyler Jones, et al. “Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial.J Am Coll Cardiol 72, no. 14 (October 2, 2018): 1563–72. https://doi.org/10.1016/j.jacc.2018.07.046.
Baumgartner I, Norgren L, Fowkes FGR, Mulder H, Patel MR, Berger JS, et al. Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial. J Am Coll Cardiol. 2018 Oct 2;72(14):1563–72.
Baumgartner, Iris, et al. “Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial.J Am Coll Cardiol, vol. 72, no. 14, Oct. 2018, pp. 1563–72. Pubmed, doi:10.1016/j.jacc.2018.07.046.
Baumgartner I, Norgren L, Fowkes FGR, Mulder H, Patel MR, Berger JS, Jones WS, Rockhold FW, Katona BG, Mahaffey K, Hiatt WR, Executive Committee and Investigators of the EUCLID Trial. Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial. J Am Coll Cardiol. 2018 Oct 2;72(14):1563–1572.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 2, 2018

Volume

72

Issue

14

Start / End Page

1563 / 1572

Location

United States

Related Subject Headings

  • Stroke
  • Popliteal Artery
  • Peripheral Arterial Disease
  • Myocardial Infarction
  • Male
  • Lower Extremity
  • Ischemia
  • Humans
  • Hemorrhage
  • Femoral Artery