Markers of Optimal Medical Therapy are Associated with Improved Limb Outcomes After Elective Revascularization for Intermittent Claudication.

INTRODUCTION: Optimal medical therapy (OMT) is a modifiable factor that reduces mortality and cardiovascular events in patients with severe peripheral arterial disease. We hypothesized preintervention OMT would be associated with improved 1-year reintervention and major adverse limb event (MALE) rates following elective endovascular revascularization for intermittent claudication (IC). METHODS: Using the Vascular Quality Initiative (2010-2020), we identified patients with IC undergoing elective endovascular, hybrid, and open surgical interventions. Preoperative antiplatelet, statin, and non-smoking status defined OMT components and created three groups: complete (all components), partial (1-2 components), and no OMT. The primary outcome was 1-year reintervention. Secondary outcomes included MALE and factors associated with OMT usage. Multivariable logistic regression generated adjusted odds ratios (aOR). RESULTS: 39,088 patients (14,907 [38.1%] complete, 22,054 [56.4%)] partial, 2,127 [5.4%] no OMT) met criteria. Patients with any OMT were more frequently older with more cardiovascular diseases and diabetes (p<0.0001). Patients without OMT were more likely to be Black or with Medicare/Medicaid (p<0.05). Observed 1-year reintervention (5.3% complete OMT, 6.1% partial OMT, 8.3% no OMT; p<0.001) and MALE (5.6% complete OMT, 6.3% partial OMT, 8.8% no OMT; p<0.001) were decreased by partial or complete OMT compared to no OMT. Complete OMT significantly reduced the adjusted odds of re-intervention and MALE by 28% (aOR=0.72, 95% confidence interval [95%CI] 0.59-0.88) and 30% (aOR=0.70, 95%CI 0.58-0.85), respectively, compared to no OMT. Partial OMT reduced the adjusted odds of re-intervention and MALE by 24% (aOR=0.76, 95%CI 0.63-0.92) and 26% (aOR=0.74, 95%CI 0.62-0.89), respectively. CONCLUSIONS: Preintervention OMT is an underutilized, modifiable risk factor associated with improved one-year reintervention and MALE. Vascular surgeons are uniquely positioned to initiate and maintain OMT in patients with IC prior to revascularization to optimize patient outcomes.

[Lung Ultrasound: new Opportunities for a Cardiologist].

This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.