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The association of calcium channel blocker with risk of adverse limb events in patients with chronic limb-threatening ischemia after endovascular treatment

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Abstract

Symptoms of lower-extremity artery disease (LEAD) emerge from impaired vascularization in distal circulation of the extremities. Calcium channel blockers (CCB) can improve distal circulation when used as adjunctive therapy with endovascular treatment (EVT), but few studies have evaluated that. We investigated the relationship between CCB therapy and post-EVT outcomes. Through a consecutive EVT registry, we evaluated those relationships in whole cohort and the following 2 subgroups; the patients suffered from intermittent claudication (IC) or chronic limb-threatening ischemia (CLTI), with adjusting baseline characteristics by propensity score matchings. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, a composite endpoint of all death, nonfatal myocardial infarction, and nonfatal stroke), and major adverse limb event (MALE, a composite of major amputation, acute limb ischemia, and surgical reintervention). The group that received CCB had less MALE in whole cohort (HR 0.31; 95% confidence interval (CI) 0.20–0.47), and less MACCE and MALE in CLTI cohort (HR 0.67; 0.50–0.89 and 0.32; 0.20–0.52 respectively) compared to the group that did not receive CCB. The relationships were common in the cohorts with baseline adjustment. MACCE and MALE in IC (HR 1.01; 0.57–1.80 and 0.60; 0.25–1.45, respectively) showed no significant differences both with and without baseline adjustment. CCB use was related to fewer MACCE and MALE events in adjusted patients who underwent EVT, and the trend was more evident, especially in the adjusted CLTI cohort. This study highlights the necessity of future studies regarding CCB. Clinical Trial Registration: URL: https://www.umin.ac.jp; Unique identifiers: UMIN000015100.

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Data availability

The data that support the findings of this study are available from the corresponding author, [M.H.], upon reasonable request.

Abbreviations

CCB:

Calcium channel blockers

CLTI:

Chronic limb–threatening ischemia

EVT:

Endovascular treatment

HR:

Hazard ratio

IC:

Intermittent claudication

LEAD:

Lower extremity artery disease

MACCE:

Major adverse cardiac and cerebrovascular events

MALE:

Major adverse limb events

MI:

Myocardial infarction

PSM:

Propensity score matching

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Acknowledgements

The authors acknowledge the patients, the staff, and members of TOMA code registry.

Author information

Authors and Affiliations

  1. Department of Cardiology, Kameda Medical Center, 929 Higashityo, Chiba, 296-8602, Japan

    Daisuke Ueshima

  2. Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan

    Michiaki Higashitani

  3. Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan

    Atsushi Mizuno

  4. Department of Cardiology, Toranomon Hospital, Tokyo, Japan

    Takahide Kodama & Tetsuo Yamaguchi

  5. Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan

    Kazuki Tobita

  6. Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan

    Toru Miyazaki

  7. Department of Cardiology, Tokyo Teishin Hospital, Tokyo, Japan

    Tetsuo Yamanaka

  8. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

    Shuhei Tara

  9. Department of Cardiology, Tokyo Medical University, Tokyo, Japan

    Naotaka Murata

Authors
  1. Daisuke Ueshima
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  2. Michiaki Higashitani
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  3. Atsushi Mizuno
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  4. Takahide Kodama
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  10. Tetsuo Yamaguchi
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Toma-Code Registry Investigators

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Correspondence to Daisuke Ueshima.

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Ueshima, D., Higashitani, M., Mizuno, A. et al. The association of calcium channel blocker with risk of adverse limb events in patients with chronic limb-threatening ischemia after endovascular treatment. Cardiovasc Interv and Ther 38, 327–337 (2023). https://doi.org/10.1007/s12928-023-00925-y

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  • DOI: https://doi.org/10.1007/s12928-023-00925-y

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