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PLoS One. 2014 Feb 26;9(2):e90201. doi: 10.1371/journal.pone.0090201. eCollection 2014.

Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

Author information

  • 1Department of Internal Medicine, Taoyuan General Hospital, Taoyuan City, Taiwan ; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan ; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
  • 2Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan ; Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
  • 3Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan ; Department of Nuclear Medicine, National Taiwan University Hospital, Taipei City, Taiwan ; Department of Nuclear Medicine and Cardiovascular Medical Center (Cardiology), Far Eastern Memorial Hospital, New Taipei City, Taiwan ; National Yang-Ming University School of Medicine, Taipei City, Taiwan.
  • 4Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
  • 5Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
  • 6Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan ; Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan.
  • 7Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan.
  • 8Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan ; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.

Abstract

OBJECTIVE:

The clinical implication of the coronary artery calcium score (CS) is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes.

METHODS AND RESULTS:

Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years) were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03). During the follow-up period (21±11 months), 29 (35%) patients underwent amputation, and 24 (29%) patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03) and a 5.16-fold (95% CI 1.13-21.61, p = 0.04) higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment.

CONCLUSION:

Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

PMID:
24587279
[PubMed - indexed for MEDLINE]
PMCID:
PMC3936008
Free PMC Article
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