Medical therapy for PVI reduces repeat procedures

The use of aspirin, statins and lifestyle changes prior to elective peripheral vascular intervention for peripheral arterial disease (PAD) may reduce the risk for repeat procedures within six months, according to researchers. However, about half of patients failed to receive this therapy, the researchers found.

"Overall we have shown that patients presenting for elective invasive management of lifestyle-limiting PAD often do not receive the basic elements of medical therapy," wrote P. Michael Grossman, M.D., of the University of Michigan in Ann Arbor, Mich., and colleagues. "The use of statin therapy only improves modestly at discharge. The application of medical therapy appears to be associated with both the patient's clinical history and demographics."

The authors examined the association between the quality of medical therapy in patients who receive percutaneous interventions for the indication of lifestyle-limiting claudication and clinical outcomes.

The authors identified 1,357 patients who underwent elective percutaneous interventions from 2007 through 2009. Upon admission, 85% of patients were using aspirin, 76% were using a statin and 68% were using both. At discharge, prescribed use of aspirin increased to 92%, statin use increased to 81% and prescribed use of both increased to 76.5%.

The authors found no difference in cardiovascular events between those taking aspirin and statin on admission and those who were not; however, patients taking aspirin and statin therapy prior to PVI were significantly less likely to undergo repeat intervention, amputation or limb-salvation surgery within six months (either aspirin or statin: odds ratio, 0.67; 95% CI, 0.53–0.84; both drugs: odds ratio, 0.45; 95% CI, 0.29-0.71).

"The modest improvement in statin prescription at discharge signifies a missed opportunity to provide a life-saving intervention for PAD patients," the authors wrote. "The prescription of secondary prevention medications in an in-hospital setting has been shown to improve long-term compliance in a CAD population."

They suggest that future research look at why medical therapy is underused in this high-risk patient group and that collaborative continuous quality improvement programs be explored and expanded to improve care.

The study was published online Dec. 11, 2012 in Circulation: Cardiovascular Interventions.