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

J Am Coll Cardiol. 2018 Oct 2;72(14):1563-1572. doi: 10.1016/j.jacc.2018.07.046.

Abstract

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).

Keywords: acute limb ischemia; cardiovascular event; diabetes; lower extremity revascularization; peripheral artery disease; smoking.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amputation, Surgical / statistics & numerical data
  • Blood Vessel Prosthesis Implantation
  • Endarterectomy
  • Endovascular Procedures*
  • Female
  • Femoral Artery / surgery
  • Hemorrhage / epidemiology
  • Humans
  • Ischemia / epidemiology
  • Lower Extremity / blood supply*
  • Lower Extremity / surgery*
  • Male
  • Myocardial Infarction / epidemiology
  • Peripheral Arterial Disease / surgery*
  • Popliteal Artery / surgery
  • Stroke / epidemiology

Associated data

  • ClinicalTrials.gov/NCT01732822