Key result
Patients with critical limb-threatening ischaemia had a higher 3-year mortality risk than those with myocardial infarction (HR 1.69; 95% CI 1.64-1.74) and were less likely to receive evidence-based therapies.
Why the study?
Patients with critical limb-threatening ischaemia (CLTI) have unclear practice patterns of evidence-based medical therapy and mortality compared with patients with myocardial infarction (MI).
Are patients with critical limb-threatening ischaemia less likely to receive evidence-based medical therapy and at higher risk of mortality compared to patients with myocardial infarction?
Cohort (n=92,845)
Yes
Are patients with critical limb-threatening ischaemia less likely to receive evidence-based medical therapy and at higher risk of mortality compared to patients with myocardial infarction?
Patients with critical limb-threatening ischaemia are significantly undertreated with evidence-based medical therapies and have higher 3-year mortality compared to patients with myocardial infarction, highlighting a major gap in guideline implementation.
Answers are grounded in this paper and cite their sources.
Undertreatment in critical limb-threatening ischaemia warrants clinical attention; leaves open whether closing the gap narrows excess mortality versus myocardial infarction.
AIMS: To describe the practice patterns of evidence-based medical therapy (EBM) and overall mortality in high-risk patients with critical limb-threatening ischaemia (CLTI), compared with patients with myocardial infarction (MI). METHODS AND RESULTS: Using Danish registries, we identified patients 40-100 years of age with a first-time hospitalization for CLTI or MI from 2008-2018 and grouped them into CLTI, MI, and CLTI and history of MI (CLTI + MI). We examined the likelihood of filling prescriptions with EBM [i.e. antiplatelets (Aps), lipid-lowering agents (LLAs), angiotensin-converting enzyme inhibitor (ACEi), or angiotensin II-receptor blockers (ARBs)] within 3 months after discharge among survivors. Further, we assessed the adjusted 3-year mortality rates. We included 92 845 patients: 14 941 with CLTI (54.7% male), 74 830 with MI (64.6% male) and 3,074 with CLTI + MI (65.2% male). Patients with CLTI and CLTI + MI were older and had more comorbidities than patients with MI. Compared with patients with MI, the unadjusted odds ratios of filling prescriptions were 0.15 [confidence interval (CI): 0.14-0.15] for AP, 0.26 (CI: 0.25-0.27) for LLA, and 0.71 (CI: 0.69-0.74) for ARB/ACEi in patients with CLTI, and 0.22 (CI: 0.20-0.24) for AP, 0.38 (CI: 0.35-0.42) for LLA, and 1.17 (CI: 1.08-1.27) for ARB/ACEi in patients with CLTI + MI. Adjusted analyses showed similar results. Compared with patients with MI, adjusted 3-year hazard ratios for mortality were 1.69 (CI: 1.64-1.74) in patients with CLTI and 1.60 (CI: 1.51-1.69) in patients with CLTI + MI. CONCLUSION: Patients with CLTI were undertreated with EBM and carried a more adverse prognosis, as compared with patients with MI, despite similar guidelines.
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Bager et al. (2023) conducted a cohort in Critical limb-threatening ischaemia and myocardial infarction (n=92,845). Critical limb-threatening ischaemia (CLTI) vs. Myocardial infarction (MI) was evaluated on 3-year mortality (HR 1.69, 95% CI 1.64-1.74). Patients with critical limb-threatening ischaemia had a higher 3-year mortality risk than those with myocardial infarction (HR 1.69; 95% CI 1.64-1.74) and were less likely to receive evidence-based therapies.
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