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Long-Term Comparative Outcomes of Patients With Peripheral Artery Disease With and Without Concomitant Coronary

Debbie C Chen1, Gagan D Singh2, Ehrin J Armstrong3

  • 1Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.

The American Journal of Cardiology
|March 6, 2017
PubMed

Insights

Patients with peripheral artery disease (PAD) and coronary artery disease (CAD) showed higher guideline-directed medical therapy (GDMT) use but increased mortality risk. Concomitant CAD significantly elevated mortality risk in PAD patients over five years.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Clinical Outcomes Research

Background:

  • Guideline-directed medical therapy (GDMT) is crucial for managing peripheral artery disease (PAD).
  • Limited contemporary data exist on GDMT utilization and long-term outcomes in PAD patients with concurrent coronary artery disease (CAD).
  • Understanding these outcomes is vital for optimizing patient care and risk stratification.

Purpose of the Study:

  • To evaluate GDMT utilization in PAD patients with and without concomitant CAD.
  • To determine the long-term clinical outcomes, including major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality, in these patient groups.
  • To identify CAD as an independent risk factor for adverse outcomes in PAD.

Main Methods:

  • Retrospective analysis of 879 patients with claudication or critical limb ischemia (CLI) undergoing vascular procedures from 2006-2013.
  • Assessment of GDMT use at the time of angiography.
  • 5-year follow-up for MACCE and all-cause mortality, analyzed using Cox proportional hazard modeling.

Main Results:

  • Patients with PAD and concomitant CAD demonstrated higher adherence to GDMT (aspirin, ACEI/ARB, statins).
  • Unadjusted 5-year rates of MACCE and all-cause mortality were significantly higher in patients with PAD and CAD (HR 1.7 and 1.86, respectively).
  • Adjusted analysis revealed CAD as an independent risk factor for mortality (aHR 1.35) but not MACCE in PAD patients. In CLI patients, CAD independently increased MACCE (aHR 1.52) and mortality (aHR 1.64).

Conclusions:

  • Despite superior GDMT use, PAD patients with concurrent CAD face a substantially elevated risk of all-cause mortality over five years post-procedure.
  • Concomitant CAD poses a particularly high risk for both MACCE and mortality in the critical limb ischemia (CLI) subgroup.
  • These findings underscore the need for intensified management strategies in PAD patients with coexisting CAD.

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