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Correlation of coronary with peripheral arterial stenosis. The POSCH Group
J N Karnegis1, J P Matts, N Tuna
1University of Nebraska, Omaha.
Insights
Coronary artery disease does not always mean peripheral arterial disease is present. However, when peripheral arterial disease occurs, its severity correlates with coronary artery stenosis severity.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Interventional Cardiology
Background:
- Peripheral arterial disease (PAD) is a known risk factor for coronary arterial stenosis.
- The relationship between coronary artery disease (CAD) and peripheral arterial stenosis has not been extensively studied.
Purpose of the Study:
- To investigate the correlation between coronary artery stenosis and peripheral arterial stenosis.
- To determine if CAD predicts the presence or severity of peripheral arterial stenosis.
Main Methods:
- Systematic analysis of coronary and aortic-iliac-femoral arteriograms.
- Utilized data from the Program on Surgical Control of the Hyperlipidemias (POSCH) trial.
- Included 436 hyperlipidemic subjects with a history of myocardial infarction and confirmed CAD.
Main Results:
- 44% of subjects had normal aortic-iliac-femoral arteries.
- Only 9% had less than 50% stenosis in all three major coronary arteries.
- A significant positive correlation (P < 0.001) was found between the severity of stenosis in peripheral and coronary arteries.
- Subjects with peripheral arterial disease were older and more likely to be smokers.
Conclusions:
- Coronary artery stenosis does not invariably coexist with peripheral arterial stenosis.
- The severity of peripheral arterial stenosis correlates with the severity of coronary artery stenosis.
- A significant proportion of patients with coronary artery disease may not have significant peripheral arterial disease.
Abstract:
Although it is known that patients with peripheral arterial disease are at high risk for coronary arterial stenosis, it is not known if, conversely, coronary artery disease correlates with peripheral arterial stenosis. In the Program on Surgical Control of the Hyperlipidemias (POSCH) coronary and aortic-iliac-femoral arteriograms were systematically analyzed. POSCH is a randomised, controlled secondary intervention clinical trial of hyperlipidemic subjects, ages 30-64 years with one myocardial infarction and angiographically demonstrable coronary arterial stenosis. Of the 838 subjects enrolled in the study, 436 had diagnostic visualization of both the coronary and aortic-iliac-femoral systems. The aortic-iliac-femoral arteries were normal in 44% (194/436) of the subjects. In contrast, only 9% (37/436) of the subjects had less than 50% stenosis of all 3 coronary arteries. However, there was a positive correlation between the severity of the stenosis, if present, in the aortic-iliac-femoral arteries and that in the coronary arteries (P less than 0.001). The subjects who did exhibit aortic-iliac-femoral arterial disease were significantly older and more frequently were cigarette smokers. We conclude that subjects with coronary arterial stenosis frequently are free of peripheral arterial disease.
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