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Effect of peripheral arterial disease in patients undergoing percutaneous coronary intervention with intracoronary
Mandeep Singh1, Ryan J Lennon, Dawood Darbar
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Insights
Patients with coronary artery disease and peripheral arterial disease (PAD) undergoing stenting had lower procedural success and worse short-term and long-term outcomes, including higher mortality and revascularization needs, compared to those without PAD.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery disease (CAD) and peripheral arterial disease (PAD) often coexist.
- Percutaneous coronary intervention (PCI) with intracoronary (IC) stent implantation is a common treatment for CAD.
- The impact of PAD on outcomes after PCI for CAD is not fully understood.
Purpose of the Study:
- To compare the short-term and long-term outcomes of patients with CAD and PAD versus those with isolated CAD after IC stent implantation during PCI.
- To evaluate procedural success and major adverse cardiovascular events in these patient groups.
Main Methods:
- Retrospective analysis of 7696 patients undergoing PCI with IC stent implantation.
- Comparison of outcomes between 1397 patients with CAD and PAD (group 2) and 6299 patients with isolated CAD (group 1).
- Statistical analysis including Kaplan-Meier survival estimates and adjusted hazard ratios.
Main Results:
- Patients with CAD and PAD were older and had more comorbidities (hypertension, diabetes, hyperlipidemia, smoking) and multivessel disease.
- Procedural success was lower in group 2 (95% vs 97%).
- In-hospital complications (death, myocardial infarction, need for revascularization, transfusion) were significantly higher in group 2.
- Long-term follow-up showed significantly worse survival free of major adverse cardiovascular events in group 2 (HR, 1.36).
Conclusions:
- Patients with concomitant CAD and PAD undergoing PCI with IC stent implantation experience lower procedural success and higher in-hospital complications.
- These patients also face worse short-term and long-term outcomes, including increased mortality and need for repeat revascularization.
- The presence of PAD is an independent predictor of adverse outcomes after PCI for CAD.
Objective:
To compare the short-term and long-term outcomes of patients with coronary artery disease and peripheral arterial disease (PAD) who underwent intracoronary (IC) stent Implantation during percutaneous coronary intervention (PCI) with the outcomes of patients with isolated coronary artery disease but without PAD who underwent IC stent implantation.
Patients And Methods:
We analyzed the outcomes of 7696 patients who underwent IC stent implantation during PCI at the Mayo Clinic in Rochester, Minn, between January 1996 and December 2002. Outcomes of 6299 patients (82%) with Isolated coronary artery disease and without PAD who underwent IC stent implantation (group 1) were compared with outcomes of 1397 patients (18%) with coronary artery disease and PAD (group 2) who underwent PCI with IC stent implantation.
Results:
Patients in group 2 were older (71.1+/-10.2 years vs 65.0+/-12.0 years; P<.001) and had a higher prevalence of hypertension (79% vs 61%; P<.001), diabetes mellitus (33% vs 20%; P<.001), hyperlipidemia (76% vs 70%; P<.001), and history of smoking (70% vs 63%; P<.001) compared with group 1. Prevalence of multivessel disease was higher in group 2 (79% vs 68%; P<.001). Procedural success was significantly lower In group 2 (95% vs 97%; P<.001). In-hospital complications were higher in group 2: death (3% vs 1%; P<.001), any myocardial Infarction (MI) (8% vs 5%; P<.001), death/MI/coronary artery bypass grafting (CABG)/target vessel revascularization (11% vs 7%; P<.001), and blood loss requiring transfusion (11% vs 5.8%; P<.001). After adjustment for other risk factors, the odds ratio for in-hospital death was 1.84 (95% confidence interval [CI], 1.16-2.90; P=.009), and for death/MI/CABG/target vessel revascularization, the odds ratio was 1.25 (95% CI, 1.00-1.55; P=.048) in patients with PAD treated with IC stents. Median follow-up was 3.1 years. Six-month, 1-year, and 2-year Kaplan-Meier estimates of survival free of death/MI/CABG/target vessel revascularization were 84%, 77%, and 69%, respectively, for group 2 and were significantly worse compared with group 1 (89%, 85%, and 80%, respectively; P<.001). This effect remained after adjustment for other risk factors (hazard ratio, 1.36; 95% CI, 1.22-1.51).
Conclusions:
Compared with patients who had isolated coronary artery disease but no PAD, patients with coronary artery disease and PAD had lower procedural success and higher in-hospital major cardiovascular complications, including higher blood loss requiring transfusion, after PCI with stent Implantation. On follow-up, the short-term and long-term outcomes of patients with PAD were worse, with higher mortality, MI, and need for repeated target vessel revascularization.
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