부산대학교 도서관

Background:Patients with PAD have a high risk of future cardiovascular (CVD) events and mortality. Little is known about the changes in clinical disease stage over time in PAD patients, and the association of changes in clinical disease stage with subsequent CVD events.Methods:In this analysis of the EUCLID (Examining Use of Ticagrelor in Symptomatic PAD) trial, we examined the changes in Rutherford classification* of 12,759 trial patients over 12 months. We examined the baseline characteristics of patients by change in classification at 12 months (?improved?=decreased Rutherford classification, ?no change?, or ?worsened?=increased Rutherford classification), as well as the association between clinical disease stage changes at 12 months and subsequent CVD events**.Results:Among 12,759 trial patients, 3,240 patients were classified as improved by Rutherford classification at 12 months, 8,132 as no change, and 1,387 as worsened. At 12 months, the majority of patients who were asymptomatic or had mild/moderate claudication at enrollment had no change in clinical disease stage, while over half of patients with severe claudication/pain at rest had improved clinical disease stage. Patients who worsened over 12 months were more likely to have comorbidities (diabetes, prior PCI or MI) and more events (MI, amputation, and major bleeding) by 12 months post-randomization, all p<0.001. Worsened clinical stage of disease was associated with an increased risk of all-cause death, major amputation, and a composite of CV death, MI or stroke, p<0.05 after 12 months post-randomization (Table).Discussion:Patients with comorbid conditions and prior history of CVD events at baseline and within the first 12 months of the trial were more likely to have worsening clinical disease stage at 12 months. Worsening clinical disease stage is associated with an increased risk of all-cause death, amputation, and a composite of CV death, MI, or stroke from 12 months post randomization.