Perfil epidemiológico y prevención secundaria en la primera visita del paciente claudicante a la consulta de angiología y cirugía vascular: estudio ESCUTEPAC / Risk profile and secondary prevention in the first visit of intermittent claudication patients to a vascular surgery clinic: ESCUTEPAC study

RESUMEN

INTRODUCCIÓN: El control de factores de riesgo cardiovascular y la prevención secundaria son esenciales para los pacientes con enfermedad arterial periférica (EAP) en sus estadios más precoces. Presentamos un estudio encaminado a conocer el perfil de los pacientes claudicantes y el tratamiento que reciben en la primera visita a un servicio de angiología y cirugía vascular. MATERIAL Y MÉTODOS: Estudio transversal y multicéntrico sobre 240 pacientes con EAP estadio II de Fontaine, procedentes de 24 servicios de la red pública española. Se recogieron variables sobre perfil de riesgo cardiovascular, clínica, exploración, tratamientos en curso y asociados en la consulta y decisión terapéutica. Análisis estadístico descriptivo y de asociación univariante (test «t» de Student y Chi cuadrado de Pearson). RESULTADOS: El 85,4% fueron varones, con edad media de 66,3 ± 10 años; 67,5% hipertensos, 35,3% diabéticos y 55,0% dislipidémicos; 39,6% fumadores activos y 47,9% exfumadores; 23,3% con antecedentes coronarios, el 64,6% en grado IIA, con índice tobillo-brazo medio de 0,74 ± 0,2. El 56,2% estaban previamente antiagregados y el 55,4% recibiendo estatinas. Tras la consulta el 91,7% recibían antiagregante (76,2% ácido acetilsalicílico, 9,2% clopidogrel), y se incrementó la tasa de tratamiento con estatinas al 74,6%, aunque solo fue correcto según el perfil de riesgo en el 26,4%. Solo 17 pacientes fueron derivados a unidades de tabaquismo. Se indicó un procedimiento quirúrgico en 9 casos (3,7%). CONCLUSIÓN: El paciente claudicante confirma su alto perfil de riesgo cardiovascular y está claramente infratratado respecto a las recomendaciones de las guías clínicas, especialmente en el manejo del hábito tabáquico y el tratamiento hipolipidemiante

ABSTRACT

INTRODUCTION: Both risk factor control and secondary pharmacological prevention are essential for patients with peripheral arterial disease (PAD) at early stages. A study is present that attempts to confirm the risk profile of patients with intermittent claudication, and to assess the correction of the associated treatment in their first visit to a Vascular Surgery clinic. MATERIAL AND METHODS: A multicentre, cross-sectional study was conducted on 240 patients with PAD with Fontaine stage II stage, from 24 outpatient Vascular Surgery clinics of the Spanish national health system. Variables recorded included, cardiovascular risk profile, symptoms, physical examination, current treatments, and associatednew ones, as well as the therapeutic decision. Descriptive statistics and associations were tested using Student t test and the Pearson Chi2 test. RESULTS: The study included 85.4% males, and patients had a mean age of 66.3 ± 10 years. They included 67.5% with hypertension, 35.3% with diabetes, and 55.0% with dyslipidaemia. There were 39.6% active smokers and 47.9% ex-smokers. There was confirmed coronary disease in 23.3%, and 64.6% were in Fontaine stage IIA. The mean ankle-brachial index was .74 ± .2. More than half (56.2%) of the patients already received antiplatelet therapy, and 55.4% were on statins. After the visit, 91.7% received antiplatelet therapy (76.2% Aspirin, 9.2% clopidogrel), and the statin treatment rate increased to 74.6%, although it was correct in only 26.4% of cases according to the risk profile. Only 17 patients were referred to a smoking cessation unit. A surgical procedure was indicated in 9 cases (3.7%). CONCLUSION: Patients with intermittent claudication have a high cardiovascular risk and receive a suboptimal treatment according to clinical practice guidelines, especially concerning smoking cessation and serum cholesterol management