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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous peripheral interventions in patients with non-ST elevation acute coronary syndromes performed by
Stanisław Bartuś1, Zbigniew Siudak, Michał Brzeziński
1Institute of Cradiology, Collegium Medicum, Jagiellonian University, Krakow, Poland.
Insights
Percutaneous cardiovascular and peripheral interventions are safe for patients with coronary artery disease and peripheral artery disease. Multilevel interventions show promising long-term outcomes for this high-risk group.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Coexisting coronary artery disease (CAD) and peripheral artery disease (PAD) significantly increases mortality and stroke risk.
- Patients with CAD and PAD often have comorbidities, limiting revascularization options.
- Conservative management is common, but may not optimize outcomes for these complex patients.
Purpose of the Study:
- To evaluate the safety and efficacy of complex percutaneous cardiovascular interventions in patients with both CAD and PAD.
- To assess the long-term prognosis and outcomes following combined percutaneous interventions for CAD and PAD.
Main Methods:
- A study of consecutive patients with symptomatic CAD and chronic PAD, admitted for non-ST elevation acute coronary syndrome (NSTE ACS).
- All percutaneous peripheral interventions were performed during a single hospital stay.
- Major adverse cardio- and cerebrovascular events (MACCE) were tracked during follow-up, including death, myocardial infarction, urgent revascularization, stroke/TIA, and amputation.
Main Results:
- 109 interventions were performed in 78 patients (average age 61.5 years, 80% male).
- Common sites of intervention included superficial femoral artery (81%), common iliac artery (36%), and external iliac artery (21%).
- Over a mean 18-month follow-up, 32% of patients experienced MACCE, including deaths, MIs, repeat interventions, strokes, and one amputation.
Conclusions:
- Percutaneous cardiovascular and peripheral interventions can be safely performed in patients with concomitant CAD and PAD.
- Multilevel percutaneous intervention offers a promising approach for improving long-term outcomes in this complex patient population.
Background:
The coexistence of peripheral artery disease (PAD) and multilevel atherosclerosis increases death and stroke rates in patients with coronary artery disease (CAD). Due to many comorbidities these patients are often treated conservatively without revascularisation.
Aim:
To investigate whether complex percutaneous cardiovascular interventions for CAD and PAD may improve prognosis and long-term outcome in this group of patients.
Methods:
We studied consecutive patients treated for symptomatic CAD who also had chronic PAD. The primary cause of hospital admission for all our patients was non-ST elevation acute coronary syndrome (NSTE ACS). All percutaneous peripheral interventions were performed during one hospital stay (index hospitalisation). Major adverse cardio- and cerebrovascular events (MACCE) during follow-up were defined as follows: death (cardiac and non-cardiac), myocardial infarction (MI), urgent revascularisation (surgical or repeat PCI, peripheral percutaneous intervention), stroke/TIA or amputation.
Results:
We performed 109 interventions in 78 consecutive patients with chronic peripheral artery stenoses and occlusions. The average age was 61.5+/-8.6 years and the majority were males (80%). Preinterventional angiography showed occlusions that involved the common iliac artery in 28 (36%) patients, the external iliac artery in 16 (21%) patients, internal iliac artery in 2 (3%) patients, and superficial femoral artery in 63 (81%) patients. Stenting was performed in half of the patients with a mean stent length of 69.6+/-50.3 mm. An average number of 1.24+/-0.55 stents was used for each lesion. During a mean follow-up of 18 months (range 4 to 42), there were 4 deaths, 3 MIs, 13 repeated percutaneous peripheral interventions due to restenosis in previously treated peripheral lesions, two urgent coronary interventions, two ischaemic strokes, two TIAs and one amputation. The combined follow--up MACCE end-point occurred in 32% of patients.
Conclusions:
Patients with concomitant CAD and PAD could safely undergo percutaneous cardiovascular and peripheral interventions. Multilevel intervention is associated with a promising long-term follow-up.
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