Vascular profile of patients with multivessel coronary artery disease

Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global management of patients with known coronary artery disease (CAD). We sought to retrospectively evaluate the clinical relevance of significant subclavian artery stenosis (SAS) and abdominal vessel stenosis or aneurysm (AVA) in patients undergoing coronary angiography.

Medical records of consecutive patients underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients underwent coincident diagnostic abdominal aorta angiography to evaluate abdominal vessels or subclavian angiography on the basis of clinical and angiographic criteria were analyzed.

During the study period, 724 consecutive patients (535 males, mean age 68.1+/-11 years) were enrolled (Table 2): a significant atherosclerotic disease of at least one arterial segments were observed in 198 patients (27.3%). Angiographically significant SAS was observed in 18/220 patients (8.1%) undergoing concomitant subclavian artery angiography and candidates to coronary surgery using the internal mammary artery. Ten patients with subclavian artery stenosis and upper limb ischemia underwent subclavian artery angioplasty and stenting and bypass surgery using LIMA. AVA were reported in 180 (35.7%) of 504 consecutive patients: renal artery stenosis was found in 13.1% of cases (66 patients), aortoiliac artery disease in 13.7 % (69 patients), and aortic aneurismal disease in 8.9% (45 patients). Logistic regression analyses revealed > or =3-vessel CAD (odds ratio [OR] 9.917, p=0.002), age>60 years old (OR 3.817, p=0.036), > or =3 risk factors (OR 2.8, p=0.048) as independent predictors of SAS and AVA.

Patients with multivessel CAD are frequently aged, have an high risk profile and multiple vascular atherosclerotic distributions, suggesting the usefulness of a more global and comprehensive cardiovascular approach.