Plaque Composition in the Proximal Superficial Femoral Artery and Peripheral Artery Disease Events

JACC-CARDIOVASCULAR IMAGING

卷:10

Article

McDermott, Mary M.^1,2  Kramer, Christopher M.^3,4,5  Tian, Lu⁶  Carr, James⁷  Guralnik, Jack M.⁸  Polonsky, Tamar⁹  Carroll, Timothy¹⁰  Kibbe, Melina^11,12  Criqui, Michael H.¹³  Ferrucci, Luigi¹⁴  Zhao, Lihui²  Hippe, Daniel S.¹⁵  Wilkins, John^1,2  Xu, Dongxiang¹⁵  Liao, Yihua²  McCarthy, Walter¹⁶  Yuan, Chun¹⁵ 

[1] Northwestern Univ Feinberg, Sch Med, Dept Med, 750 North Lake Shore Dr,10th Floor, Chicago, IL USA

[2] Northwestern Univ Feinberg, Sch Med, Dept Prevent Med, Chicago, IL USA

[3] Univ Virginia Hlth Syst, Dept Med, Charlottesville, VA USA

[4] Univ Virginia Hlth Syst, Dept Radiol, Charlottesville, VA USA

[5] Univ Virginia Hlth Syst, Dept Med Imaging, Charlottesville, VA USA

[6] Stanford Univ, Sch Med, Dept Hlth Res & Policy, Stanford, CA USA

[7] Northwestern Univ Feinberg, Sch Med, Dept Radiol, Chicago, IL USA

[8] Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA

[9] Univ Chicago, Dept Med, 5841 S Maryland Ave, Chicago, IL 60637 USA

[10] Univ Chicago, Dept Radiol, Chicago, IL 60637 USA

[11] Jesse Brown Vet Affairs Med Ctr, Chicago, IL USA

[12] Northwestern Univ Feinberg, Sch Med, Dept Surg, Div Vasc Surg, Chicago, IL USA

[13] NIA, Bethesda, MD 20892 USA

[14] Univ Calif San Diego, Dept Family & Prevent Med, San Diego, CA 92103 USA

[15] Univ Washington, Dept Radiol & Bioengn, Seattle, WA 98195 USA

[16] Rush Univ, Med Ctr, Univ Cardiovasc Surg, Chicago, IL 60612 USA

关键词: femoral artery;    lipid rich;    necrotic core;    MRI;    vascular medicine;   

DOI  :  10.1016/j.jcmg.2016.08.012

来源: Elsevier

【 摘 要 】

OBJECTIVES The aim of this study was to describe associations of the presence of lipid-rich necrotic core (LRNC) in the proximal superficial femoral artery (SFA) with lower extremity peripheral artery disease (PAD) event rates and systemic cardiovascular event rates. BACKGROUND LRNC in the coronary and carotid arteries is associated with adverse outcomes but has not been studied previously in lower extremity arteries. METHODS Participants with ankle-brachial index (ABI) values < 1.00 were identified from Chicago medical centers and followed annually. Magnetic resonance imaging was used to characterize SFA atherosclerotic plaque at baseline. Medical records for hospitalizations and procedures after baseline were adjudicated for lower extremity revascularization, amputation, and critical limb ischemia and also for new coronary events, ischemic stroke, and mortality. RESULTS Of 254 participants with PAD, 62 (24%) had LRNC and 149 (59%) had calcium in the SFA at baseline. Cox regression analyses were adjusted for age, sex, race, comorbidities, baseline ABI, and other confounders. SFA LRNC was associated with an increased incidence of the combined outcome of lower extremity amputation, critical limb ischemia, ABI decline > 0.15, and revascularization at 47-month follow-up (hazard ratio: 2.18; 95% confidence interval: 1.27 to 3.75; p = 0.005). The association of SFA LRNC with PAD events was maintained even when this combined outcome excluded lower extremity revascularization (hazard ratio: 2.58; 95% confidence interval: 1.25 to 5.33; p = 0.01). LRNC in the SFA was not associated with all-cause mortality, acute coronary events, or stroke. CONCLUSIONS Among patients with PAD, LRNC in the SFA was associated with higher rates of clinical PAD events, and this association was independent of ABI. Further study is needed to determine whether interventions that reduce SFA LRNC prevent PAD events. (C) 2017 by the American College of Cardiology Foundation.

【 授权许可】

Free