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CTO, previous interventions predict adverse events in LIBERTY 360° cohort

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David O’Connor

Chronic total occlusion and previous interventions and amputations were among the predictors of major adverse events at 18 months in the LIBERTY 360° cohort, according to data presented at the Society for Vascular Surgery Vascular Annual Meeting.

As Cardiology Today’s Intervention previously reported, the LIBERTY 360° study of 1,204 patients with lower-extremity peripheral artery disease, stratified by Rutherford class 2 to 3 (n = 500; mean age, 70 years; 67% men), Rutherford class 4 to 5 (n = 589; mean age, 70 years; 62% men) and Rutherford class 6 (n = 100; mean age, 68 years; 73% men), is designed to evaluate procedural, long-term clinical and economic outcomes of endovascular interventions in patients with claudication or critical limb ischemia. Treating clinicians could use whichever devices they saw fit.

Researchers previously reported that at 18 months, 76.9% from the Rutherford class 2 to 3 group, 68.2% from the Rutherford class 4 to 5 group and 52.8% from the Rutherford class 6 group were free from major adverse events such as major amputation and reintervention.

At the Society for Vascular Surgery Vascular Annual Meeting, David O’Connor, MD, FACS, assistant professor of surgery and director of vascular research at Hackensack University Medical Center, presented predictors of major adverse events at 18 months.

In a multivariable model, he said the following factors independently predicted major adverse events at 18 months:

• CTO (HR = 1.78; 95% CI, 1.36-2.33);

• number of wounds on target limb at baseline (HR per 1-unit increase = 1.33; 95% CI, 1.2-1.49);

• previous peripheral vascular interventions for PAD (HR = 1.61; 95% CI, 1.25-2.08);

• number of target limb procedures in previous 3 years (HR per one-procedure increase = 1.09; 95% CI, 1.03-1.14);

• total treated lesion length (HR per 1-cm increase = 1.01; 95% CI, 1-1.02);

• previous above-ankle major amputation on non-target limb (HR = 1.78; 95% CI, 1.12-2.84); and

• history of MI (HR = 1.32; 95% CI, 1.02-1.71).

“When assessing long-term outcomes in PAD patients treated with endovascular devices, many traditional predictors are significant in an unadjusted model, yet when accounting for potential covariates, those associated with disease progression and previous treatments were most strongly correlated with 18-month [major adverse events],” O’Connor said during the presentation. – by Erik Swain

Reference:

O’Connor D, et al. S8: Scientific Session 8. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 20-23, 2018; Boston.

Disclosure: The study was funded by Cardiovascular Systems Inc. O’Connor reports he serves on an advisory board for Cardiovascular Systems Inc. and has served as an investigator for trials sponsored by Boston Scientific and Spectranetics.