دورية أكاديمية
Contextualizing the BEST-CLI Trial Results in Clinical Practice.
| العنوان: | Contextualizing the BEST-CLI Trial Results in Clinical Practice. |
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| المؤلفون: | Butala NM; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado., Chandra V; Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California., Beckman JA; Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas., Parikh SA; Division of Cardiology, Department of Medicine, Columbia University School of Medicine, New York, New York., Lookstein R; Department of Radiology, Mt. Sinai School of Medicine, New York, New York., Misra S; Department of Radiology, Mayo Clinic, Rochester, Minnesota., Secemsky EA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. |
| المصدر: | Journal of the Society for Cardiovascular Angiography & Interventions [J Soc Cardiovasc Angiogr Interv] 2023 Jul-Aug; Vol. 2 (4). Date of Electronic Publication: 2023 May 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 9918419271306676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2772-9303 (Electronic) Linking ISSN: 27729303 NLM ISO Abbreviation: J Soc Cardiovasc Angiogr Interv Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York] : Elsevier Inc., [2022]- |
| مستخلص: | Background: Chronic limb-threatening ischemia (CLTI) is associated with poor long-term outcomes. Although prompt revascularization is recommended, the optimal revascularization strategy remains uncertain. The BEST-CLI trial compared endovascular and open surgical revascularization for CLTI, but the generalizability of this study to the clinical population with CLTI has not been evaluated. Methods: We included Medicare beneficiaries aged 65-85 years with CLTI who underwent revascularization and would be eligible for enrollment in BEST-CLI between 2016 and 2019. The primary exposure was type of revascularization (endovascular vs autologous graft [cohort 1] vs nonautologous graft [cohort 2]), and the primary outcome was a composite of major adverse limb events (MALE) and death. MALE included above-ankle amputation and major intervention, which was defined as new bypass of index limb, thrombectomy, or thrombolysis. Results: A total of 66,153 patients were included in this study (10,125 autologous grafts; 7867 nonautologous grafts; 48,161 endovascular). Compared with those enrolled in BEST-CLI cohort 1, patients in this study were older (mean age, 73.5 ± 5.7 vs 69.9 ± 9.9 years), more likely to be female (38.3% [22,340/58,286] vs 28.5% [408/1434]), and presented with more comorbidities. Endovascular operators for the study population vs BEST-CLI cohort 1 were less likely to be surgeons (55.9% [26,924/48,148] vs 73.0% [520/708]) and more likely to be cardiologists (25.5% [5900/48,148] vs 14.5% [103/78]). When assessing long-term outcomes, the crude risk of death or MALE in this cohort was higher with surgery (56.6% autologous grafts vs 42.6% BEST-CLI cohort 1 at a median of follow-up 2.7 years; 51.6% nonautologous grafts vs 42.8% BEST-CLI cohort 2 at a median follow-up of 1.6 years) but similar with the endovascular cohort (58.7% Medicare vs 57.4% cohort 1 at 2.7 years; 47.0% Medicare vs 47.7% cohort 2 at 1.6 years). Of those who received endovascular treatment, the risk of incident major intervention was less than half in this cohort compared with the trial cohort (10.0% Medicare vs 23.5% cohort 1 at 2.7 years; 8.6% Medicare vs 25.6% cohort 2 at 1.6 years), although technical endovascular failures were not captured. Conclusions: These results suggest that the findings of the BEST-CLI trial may not be applicable to the entirety of the Medicare population of patients with CLTI undergoing revascularization. |
| References: | JAMA. 2023 Apr 25;329(16):1376-1385. (PMID: 37097356) J Vasc Surg. 2016 Jan;63(1):270-8. (PMID: 26603542) J Vasc Surg. 2019 Jun;69(6S):3S-125S.e40. (PMID: 31159978) Circulation. 2017 Mar 21;135(12):e726-e779. (PMID: 27840333) N Engl J Med. 2022 Dec 22;387(25):2305-2316. (PMID: 36342173) J Vasc Surg. 2015 Dec;62(6):1642-51.e3. (PMID: 26391460) Ann Vasc Surg. 2020 Jan;62:406-411. (PMID: 31491479) J Am Heart Assoc. 2016 Jul 08;5(7):. (PMID: 27402237) |
| معلومات مُعتمدة: | K23 HL150290 United States HL NHLBI NIH HHS; R01 HL098967 United States HL NHLBI NIH HHS |
| فهرسة مساهمة: | Keywords: chronic limb-threatening ischemia; endovascular; outcomes; revascularization |
| تواريخ الأحداث: | Date Created: 20230814 Latest Revision: 20231103 |
| رمز التحديث: | 20240829 |
| مُعرف محوري في PubMed: | PMC10417884 |
| DOI: | 10.1016/j.jscai.2023.101036 |
| PMID: | 37575528 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2772-9303 |
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| DOI: | 10.1016/j.jscai.2023.101036 |