TY - JOUR
T1 - Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease
T2 - Six-month outcomes from the claudication: Exercise versus endoluminal revascularization (CLEVER) study
AU - Murphy, Timothy P.
AU - Cutlip, Donald E.
AU - Regensteiner, Judith G.
AU - Mohler, Emile R.
AU - Cohen, David J.
AU - Reynolds, Matthew R.
AU - Massaro, Joseph M.
AU - Lewis, Beth A.
AU - Cerezo, Joselyn
AU - Oldenburg, Niki C.
AU - Thum, Claudia C.
AU - Goldberg, Suzanne
AU - Jaff, Michael R.
AU - Steffes, Michael W.
AU - Comerota, Anthony J.
AU - Ehrman, Jonathan
AU - Treat-Jacobson, Diane
AU - Walsh, M. Eileen
AU - Collins, Tracie
AU - Badenhop, Dalynn T.
AU - Bronas, Ulf
AU - Hirsch, Alan T.
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2012/1/3
Y1 - 2012/1/3
N2 - Background-: Claudication is a common and disabling symptom of peripheral artery disease that can be treated with medication, supervised exercise (SE), or stent revascularization (ST). Methods and Results-: We randomly assigned 111 patients with aortoiliac peripheral artery disease to receive 1 of 3 treatments: optimal medical care (OMC), OMC plus SE, or OMC plus ST. The primary end point was the change in peak walking time on a graded treadmill test at 6 months compared with baseline. Secondary end points included free-living step activity, quality of life with the Walking Impairment Questionnaire, Peripheral Artery Questionnaire, Medical Outcomes Study 12-Item Short Form, and cardiovascular risk factors. At the 6-month follow-up, change in peak walking time (the primary end point) was greatest for SE, intermediate for ST, and least with OMC (mean change versus baseline, 5.8±4.6, 3.7±4.9, and 1.2±2.6 minutes, respectively; P<0.001 for the comparison of SE versus OMC, P=0.02 for ST versus OMC, and P=0.04 for SE versus ST). Although disease-specific quality of life as assessed by the Walking Impairment Questionnaire and Peripheral Artery Questionnaire also improved with both SE and ST compared with OMC, for most scales, the extent of improvement was greater with ST than SE. Free-living step activity increased more with ST than with either SE or OMC alone (114±274 versus 73±139 versus -6±109 steps per hour), but these differences were not statistically significant. Conclusions-: SE results in superior treadmill walking performance than ST, even for those with aortoiliac peripheral artery disease. The contrast between better walking performance for SE and better patient-reported quality of life for ST warrants further study. Clinical Trial Registration-: URL: http://clinicaltrials.gov/ct/ show/NCT00132743?order=1. Unique identifier: NCT00132743.
AB - Background-: Claudication is a common and disabling symptom of peripheral artery disease that can be treated with medication, supervised exercise (SE), or stent revascularization (ST). Methods and Results-: We randomly assigned 111 patients with aortoiliac peripheral artery disease to receive 1 of 3 treatments: optimal medical care (OMC), OMC plus SE, or OMC plus ST. The primary end point was the change in peak walking time on a graded treadmill test at 6 months compared with baseline. Secondary end points included free-living step activity, quality of life with the Walking Impairment Questionnaire, Peripheral Artery Questionnaire, Medical Outcomes Study 12-Item Short Form, and cardiovascular risk factors. At the 6-month follow-up, change in peak walking time (the primary end point) was greatest for SE, intermediate for ST, and least with OMC (mean change versus baseline, 5.8±4.6, 3.7±4.9, and 1.2±2.6 minutes, respectively; P<0.001 for the comparison of SE versus OMC, P=0.02 for ST versus OMC, and P=0.04 for SE versus ST). Although disease-specific quality of life as assessed by the Walking Impairment Questionnaire and Peripheral Artery Questionnaire also improved with both SE and ST compared with OMC, for most scales, the extent of improvement was greater with ST than SE. Free-living step activity increased more with ST than with either SE or OMC alone (114±274 versus 73±139 versus -6±109 steps per hour), but these differences were not statistically significant. Conclusions-: SE results in superior treadmill walking performance than ST, even for those with aortoiliac peripheral artery disease. The contrast between better walking performance for SE and better patient-reported quality of life for ST warrants further study. Clinical Trial Registration-: URL: http://clinicaltrials.gov/ct/ show/NCT00132743?order=1. Unique identifier: NCT00132743.
KW - claudication
KW - comparative effectiveness research
KW - peripheral artery disease
KW - vascular diseases
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U2 - 10.1161/CIRCULATIONAHA.111.075770
DO - 10.1161/CIRCULATIONAHA.111.075770
M3 - Article
C2 - 22090168
AN - SCOPUS:83655214994
VL - 125
SP - 130
EP - 139
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 1
ER -