Chronic kidney disease and risk for cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease: The EUCLID trial
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<jats:p> In patients with symptomatic peripheral artery disease (PAD), the impact of chronic kidney disease (CKD) on major adverse cardiovascular events has not been fully evaluated. The Examining Use of Ticagrelor In PAD (EUCLID) trial randomized 13,885 patients with PAD to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily. This post hoc analysis compared the incidence of the primary composite endpoint (cardiovascular death, myocardial infarction (MI), or ischemic stroke) in patients with CKD (eGFR < 60 mL/min/1.73 m<jats:sup>2</jats:sup>) with those without CKD (eGFR ⩾ 60 mL/min/1.73 m<jats:sup>2</jats:sup>). The primary safety endpoint was thrombolysis in MI (TIMI) major bleeding. A total of 13,483 patients were included; 3332 (25%) had CKD, of whom 237 had stage 4/5 disease. Median follow-up was approximately 30 months. After statistical adjustment, patients with CKD had a higher rate of the primary endpoint compared with those without CKD (6.75 vs 3.72 events/100 patient-years; adjusted hazard ratio (HR) 1.45, 95% CI 1.30–1.63). CKD was not associated with increased risk of hospitalization for acute limb ischemia (ALI) (adjusted HR 0.96, 95% CI 0.69–1.34) or major amputation (adjusted HR 0.92, 95% CI 0.66–1.28). CKD was not associated with a significantly increased risk of major bleeding (adjusted HR 1.21, 95% CI 0.89–1.64), but minor bleeding was significantly increased (adjusted HR 1.51, 95% CI 1.07–2.15). In conclusion, patients with PAD and CKD had higher rates of cardiovascular death, MI, and ischemic stroke, but similar rates of ALI, major amputation, and TIMI major bleeding when compared with patients without CKD. ClinicalTrials.gov Identifier: NCT01732822 </jats:p>
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Hopley, Charles W, Sarah Kavanagh, Manesh R Patel, Cara Ostrom, Iris Baumgartner, Jeffrey S Berger, Juuso I Blomster, F Gerry R Fowkes, et al. (n.d.). Chronic kidney disease and risk for cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease: The EUCLID trial. Vascular Medicine. pp. 1358863X1986417–1358863X1986417. 10.1177/1358863x19864172 Retrieved from https://hdl.handle.net/10161/19116.
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Manesh Raman Patel
Manesh Patel is the Chief of the Division of Cardiology and the Division of Clinical Pharmacology. His clinical interests include diagnostic and interventional coronary angiography, peripheral angiography and endovascular intervention. His is involved in several clinical trials involving patients with cardiovascular disease and in cardiac imaging. He is also the Chair of the American College of Cardiology Task Force for Appropriate Use Criteria for Cardiovascular Procedures and is Chair of the American Heart Association Diagnostic and Interventional Cath Committee.
Patel's interest in cardiac imaging, quality of care, cardiac devices is also evident in his research. His integration of these efforts into his roles at Duke was recognized in 2010 when he received the prestigious Duke Cardiology Fellowship Mentor Award. In 2011, Dr. Patel was named the endowed John Bush Simpson Assistant Professor of Cardiology. In 2013, Dr. Patel received the Robert M. Califf Faculty clinical research Award.
Currently, Dr. Patel is leading an effort to redesign the delivery of care to patients undergoing invasive catheterization procedures in the health system with a specific aim of measure and providing individualized, patient centered, innovative, and efficient care.
William Schuyler Jones
I am an interventional cardiologist with a specific focus on the diagnosis and treatment of patients with cardiovascular disease. As a clinician, I see patients in the office and do coronary and peripheral vascular procedures (angiography and interventions) in the Duke Cardiac Catheterization Laboratory. I have served as the Medical Director of the cath lab at Duke since 2016. Alongside my partners in the cath lab, we collaborate with our cardiothoracic surgeons to hold Heart Team meetings each week, and we frequently are asked to address complex cardiovascular issues as a multidisciplinary team.
I also have a broad background in cardiovascular site-based research, multicenter clinical trials, clinical event classification, and observational analyses. I have helped to lead clinical trial efforts at the Duke Clinical Research Institute (DCRI) by designing and conducting studies evaluating new and existing treatments for patients with coronary artery disease and peripheral artery disease. My specific research interests include examining access to care and disparities in care for patients with peripheral artery disease and the design and conduct of pragmatic clinical trials in cardiovascular disease.
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