MS363 CHANGES OF sEMG ACTIVITY IN PROXIMAL AND DISTAL LEG MUSCLES IN PATIENTS WITH CLAUDICATION OVER 12-WEEK TREADMILL TRAINING – THE PILOT STUDY (original) (raw)
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International Journal of Cardiology, 2021
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Comparative effectiveness review of antiplatelet agents in peripheral artery disease
Journal of the American Heart Association, 2014
Institute of Medicine as one of the top 100 priorities for comparative effectiveness research because of the large population of patients affected with significant morbidity and mortality, the multiple potential treatment options, and the high costs of care to the health care system. 1 The goal of medical therapy in patients with PAD is to reduce the risk of future cardiovascular (CV) morbidity and mortality, improve walking distance and functional status in patients with intermittent claudication (IC), and reduce amputation in patients with critical limb ischemia (CLI). Secondary prevention includes the use of antiplatelet agents and the management of other risk factors, such as tobacco use, diabetes mellitus, hyperlipidemia, and hypertension. It is not clear which antiplatelet strategy (aspirin versus clopidogrel or monotherapy versus dual antiplatelet therapy [DAPT]) is of most benefit. Furthermore, the role of these agents in patients with asymptomatic PAD is also unclear. We conducted a systematic review evaluating various treatment modalities for PAD. 2 This article, which is derived from that review, focuses on the comparative effectiveness and safety of (1) aspirin versus placebo or no antiplatelet, (2) clopidogrel versus aspirin, (3) clopidogrel plus aspirin versus aspirin alone, and (4) other antiplatelet comparisons. Methods Data Sources and Searches Searches were limited to articles published from January 1995 to August 2012. Exact search strings are listed in the full Agency for Healthcare Research and Quality (AHRQ) report. 2 We supplemented electronic searches with a manual search of references from systematic reviews and pivotal articles in the field. We also searched the gray literature of study registries and conference abstracts for relevant articles from completed studies that have not been published in a peer-reviewed journal, including ClinicalTrials.gov, the World Health Organization's International Clinical Trials Registry Platform Search Portal, and the ProQuest COS Conference Papers Index. Scientific information packets were requested from manufacturers of medications and devices and reviewed for relevant articles. Study Selection Studies were limited to adult populations aged 18 years or older with lower-extremity PAD. English-language randomized or observational studies were included. Detailed inclusion and exclusion criteria are in the full report. 2 Data Extraction and Quality Assessment Abstracted data included study design, patient characteristics overall and by study group (age, sex, and race), vascular disease risk factors (diabetes, tobacco use, chronic kidney disease, hyperlipidemia, or other comorbid diseases), and interventionspecific factors (antiplatelet therapy, and, if applicable, type of endovascular or surgical revascularization). Outcomes captured included overall morality, CV mortality, nonfatal myocardial infarction (MI), nonfatal stroke, repeat revascularization, vessel patency, and composite CV events (CVEs; CV mortality, nonfatal MI, and nonfatal stroke). Safety outcomes included adverse drug reactions and bleeding. Disagreements were resolved by consensus. We evaluated the quality of individual studies as described in the AHRQ's "Methods Guide for Effectiveness and Comparative Effectiveness Reviews," 3 assigning summary ratings of good, fair, or poor.
The Influence of Peripheral Arterial Disease on Outcomes
Journal of the American College of Cardiology, 2006
We aimed to evaluate clinical outcomes among peripheral arterial disease (PAD) patients following percutaneous coronary intervention (PCI). BACKGROUND A significant proportion of patients with coronary artery disease undergoing PCI have concomitant PAD, which may be associated with worse outcomes.
Journal of Endovascular Therapy, 2004
To determine the impact of symptomatic peripheral arterial disease (PAD) on clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Methods and Results: Symptomatic PAD was identified in 1969 (18.9%) of 10440 consecutive patients undergoing PCI. Patients with PAD were older, more frequently female, and had smaller body surface area and more atherosclerotic risk factors, chronic renal insufficiency, and heart failure. Patients with PAD had lower rates of procedural success (94.2% versus 96.2%, pϽ0.0001) and higher rates of in-hospital complications, including all-cause mortality (2.1% versus 1.1%, pϭ0.0002), cardiac death (1.5% versus 0.7%, pϭ0.0009), urgent coronary artery bypass grafting (1.9% versus 1.2%, pϭ0.01), recurrent ischemia (5.6% versus 2.8%, pϽ0.0001), re-PCI to the target lesion (2.4% versus 1.1%, pϽ0.0001), stroke (0.6% versus 0.3%, pϭ0.0344), transient ischemic attack (0.4% versus 0.1%, pϭ0.01), femoral hematoma (10.3% versus 8.5%, pϭ0.01), retroperitoneal hematoma (0.8% versus 0.3%, pϭ0.009), limb ischemia (3.0% versus 0.7%, pϽ0.0001), gastrointestinal bleeding (1.9% versus 0.9%, pϽ0.0001), and blood transfusion (10.1% versus 5.2%, pϽ0.0001). At 1-year follow-up, patients with PAD had a higher mortality rate (13.6% versus 5.2%, pϽ0.0001), a higher rate of myocardial infarction (8.3% versus 6.5%, pϭ0.008), and also more target lesion (21.2% versus 19.8%, pϭ0.02) or target vessel revascularization (24.6% versus 21.2%, pϭ0.002). By multivariate analysis, PAD was an independent predictor of 1-year mortality (odds ratio 1.71, 95% confidence interval 1.42 to 2.07, pϽ0.0001). Conclusions: Nearly a fifth of patients undergoing PCI have symptomatic PAD. The presence of PAD is associated with lower rates of procedural success, higher rates of in-hospital and 1-year adverse events, and is independently associated with increased 1-year mortality.
Journal of Vascular Surgery, 2006
Background: Patients affected by peripheral arterial disease (PAD) incur a heightened risk of adverse cardiovascular events, including stroke, myocardial infarction, and vascular mortality. We examined risk factors, medications, and prognosis of outpatients with PAD enrolled in two national, prospective, practice-based Canadian registries that encompassed 484 physician practices: the Vascular Protection and Guideline Oriented Approach in Lipid Lowering registries. Methods: The 2 registries were combined to analyze 9810 patients with vascular disease, diabetes mellitus, or age 65 years or older plus at least 2 additional cardiovascular risk factors. Risk factors, medications, and major cardiovascular events were recorded at baseline and again at 6 months' follow-up. Results: Compared with patients without PAD (n ؍ 8303), those with PAD (n ؍ 1507) had substantially worse risk factor profiles and were more likely to have coexisting coronary or cerebrovascular disease. Both groups received high rates of treatment with evidence-based therapies, including antiplatelet drugs, statins, and angiotensin-converting enzyme inhibitors. Despite this, patients with PAD had a nearly twofold higher risk of major cardiovascular events at 6 months than non-PAD patients (7.3% vs 4.1%; P < .0001). After adjustment for multiple confounding factors, the presence of PAD at baseline continued to predict a heightened risk of adverse vascular sequelae (odds ratio, 1.54; 95% confidence interval, 1.18-2.01; P < .0001).
Journal of the American College of Cardiology, 2014
This study was conducted to determine whether there is additive benefit of dual-antiplatelet therapy (DAPT) with aspirin (acetylsalicylic acid [ASA]) and clopidogrel compared with ASA monotherapy among patients with symptomatic peripheral arterial disease. Methods: This was an observational cohort analysis that included 629 patients with claudication or critical limb ischemia. The prevalence of patients taking ASA monotherapy vs DAPT was assessed monthly for up to 3 years. A propensity model was constructed to adjust for baseline demographic characteristics and to assess the effect of DAPT on major adverse cardiovascular events (MACEs) and major adverse limb events. Results: At baseline, 348 patients were taking DAPT and 281 were taking ASA monotherapy. During 3 years of follow-up, 50 events (20%) occurred in the DAPT group vs 59 (29%) in the ASA monotherapy group. After propensity weighting, DAPT use was associated with a decreased risk of MACEs (adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.96) and overall mortality (adjusted HR, 0.55; 95% CI, 0.35-0.89). No association was found between DAPT use and the risk of major amputation (adjusted HR, 0.69; 95% CI, 0.37-1.29). In a subgroup of 94 patients who underwent point-of-care platelet function testing, 21% had decreased response to ASA and 55% had a decreased response to clopidogrel. No association was found between a reduced response to ASA or clopidogrel and adverse events at 1 year. Conclusions: DAPT may be associated with reduced rates of MACEs and death among patients with symptomatic peripheral arterial disease.