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Published on: September 22, 2020
Coronary vascular dysfunction is associated with increased risk of death in patients with peripheral artery disease
Poghni A Peri-Okonny1,2, Krishna K Patel3, R Angel Garcia4,5
1Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO, USA. apoghni@gmail.com.
Insights
Coronary vascular dysfunction, indicated by myocardial blood flow reserve (MBFR) < 2, is prevalent in patients with peripheral artery disease (PAD). This dysfunction significantly increases the risk of all-cause death in PAD patients, highlighting a critical link between these conditions.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Peripheral artery disease (PAD) and coronary vascular dysfunction are frequent comorbidities in cardiometabolic disease.
- The prevalence and prognostic significance of concurrent PAD and coronary vascular dysfunction remain understudied.
Purpose of the Study:
- To investigate the prevalence of coronary vascular dysfunction in patients with PAD.
- To determine the prognostic impact of combined PAD and coronary vascular dysfunction on mortality.
Main Methods:
- Analysis of consecutive patients undergoing PET MPI to assess coronary vascular dysfunction (MBFR < 2).
- Utilized Cox regression to evaluate the association of reduced MBFR with mortality in PAD patients.
- Examined the combined effect of PAD and MBFR < 2 on all-cause death.
Main Results:
- 13,940 patients were analyzed; 14% had PAD, 56% had MBFR < 2, and 10% had both.
- Reduced MBFR was observed in 69.5% of patients and was linked to a 1.69-fold increased risk of death in PAD patients.
- Patients with PAD and reduced MBFR faced a 2.30-fold increased risk of death compared to those without either condition.
Conclusions:
- Coronary vascular dysfunction is highly prevalent in patients diagnosed with PAD.
- The presence of coronary vascular dysfunction in PAD patients is significantly associated with an elevated risk of mortality.
Background:
Peripheral artery disease (PAD) and coronary vascular dysfunction are common in patients with cardiometabolic disease. Neither the prevalence of coronary vascular dysfunction among patients with PAD nor the prognostic impact with these two conditions present together has been well studied.
Methods:
Consecutive patients who underwent PET MPI were analyzed for presence of coronary vascular dysfunction [myocardial blood flow reserve (MBFR) < 2]. Cox regression was used to examine the association of reduced MBFR with mortality in patients with PAD, as well as the association of comorbid MBFR < 2 and PAD with all-cause death.
Results:
Among 13,940 patients, 1936 (14%) had PAD, 7782 (56%) had MBFR < 2 and 1346 (10%) had both PAD and MBFR < 2. Reduced MBFR was very common (69.5%) and was associated with increased risk of all-cause death (HR 1.69, 95%CI 1.32, 2.16, p < 0.01) in patients with PAD. Patients with both PAD and MBFR < 2, and those with either PAD or reduced MBFR had increased risk of death compared to those with neither condition: PAD + MBFR < 2 [(HR 95%CI), 2.30; 1.97-2.68], PAD + MBFR ≥ 2 (1.37; (1.08-1.72), PAD - MBFR < 2 (1.98; 1.75-2.25), p < 0.001 for all).
Conclusion:
Coronary vascular dysfunction was common in patients with PAD and was associated with increased risk of death.
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