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Very long-term outcome of peripheral arterial disease in patients undergoing percutaneous coronary revascularization:
A Pullara1, F D'Ascenzo, A Gonella
1University of Turin, Turin, Italy. alberto.pullara@gmail.com
Insights
Peripheral arterial disease (PAD) significantly worsens outcomes for patients after percutaneous coronary intervention (PCI) with stent implantation. This condition increases risks for major adverse cardiac events, even years after the procedure.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Peripheral arterial disease (PAD) is a known risk factor for adverse events after percutaneous coronary intervention (PCI) with stent implantation.
- Limited data exists on the very long-term outcomes (beyond 1 year) for PAD patients post-PCI.
Purpose of the Study:
- To evaluate the influence of PAD on very long-term outcomes in patients who underwent PCI with stent implantation.
Main Methods:
- Retrospective analysis of 1008 patients undergoing PCI between July 2002 and June 2004.
- PAD diagnosis based on clinical and/or angiographic data.
- Follow-up averaged 4.42 years, assessing death, myocardial infarction, repeat revascularization, and major adverse cardiac events (MACE).
Main Results:
- Patients with PAD (n=109) had more comorbidities like diabetes, hypertension, and chronic renal failure.
- PAD patients showed higher rates of revascularization (53% vs. 37%), cardiac death (21% vs. 13%), and MACE (69% vs. 49%).
- PAD was an independent predictor of MACE (HR 1.31).
Conclusions:
- Peripheral arterial disease is a significant clinical factor negatively impacting very long-term outcomes for patients undergoing PCI with stent implantation.
Aim:
Peripheral arterial disease (PAD) in patients undergoing percutaneous coronary intervention (PCI) with stent implantation is a well known risk factor leading to an increased rates of stroke, cardiovascular death and myocardial infarction. Anyway there are few data on very-long term outcome (more than 1 year follow up) of PAD after stent implantation. We thus aimed to evaluate the influence of PAD on very long-term outcome of our PCI-population.
Methods:
We retrospectively identified all patients undergoing PCI with stent implantation at our center between July 2002 and June 2004, and thus eligible for at least 4 years of follow-up. For the purpose of this study, we considered a diagnosis of PAD based on clinical evaluation and/or angiographic documentation. We adjudicated the following clinical events: death, myocardial infarction, repeat revascularization, and their composite (i.e. major adverse cardiac events, MACE). RESULTS; A total of 1008 patients were included, 109 with PAD and 899 Without PAD. Those with had more often diabetes (35% vs. 25%, P=0.002), hypertension (83% vs. 68%, P=0.001) and unfavorable basal clinical condition at the start of this study: past-Percutaneous Coronary Intervention (PCI) (30% vs. 22%, P=0.005), past-Coronary Artery Bypass Graft (CABG) (24% vs. 14%, P=0.001), ejection fraction (EF) <35% (14% vs. 7%, P=0.02) and chronic renal failure (CRF) (15% vs. 6%, P=0.002). In addiction patient with PAD were more likely to have chronic total occlusion (CTO) (36% vs. 25%, p=0.02) and unprotected left main (16% vs. 8%,P=0.01). Clinical outcome at the time of follow-up (4,42 ± 1,66 years) was as follow: Revascularization (53% vs. 37%, P=0.002), Cardiac death (21% vs. 13%, P=0.04), MACE (69% vs. 49%, p<.001). Independent predictors of MACE according to our survival analysis were: PAD (HR 1.31; 95% CI 1.01-1.69), Age >75 (HR 1.23; 95% CI 1-1.51), Chronic heart failure (HR1.72; 95% CI 1.19-2.5), Unprotected left main (HR 1.48; 95% CI 1.12-1.96).
Conclusion:
This long-term registry shows that PAD remains an important clinical condition that negatively influences the outcome of patients undergoing PCI with stent implantation in a very long-term follow-up period.
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