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The Association between Major Adverse Cardiovascular Events and Peripheral Artery Disease Burden
Oskari Niiranen1, Juha Virtanen2, Ville Rantasalo1
1Department of Surgery, University of Turku, 20520 Turku, Finland.
Insights
Severe tibial atherosclerosis in peripheral artery disease (PAD) patients significantly increases the risk of Major Adverse Cardiovascular Events (MACEs), including heart failure. The risk escalates with greater atherosclerosis severity in tibial vessels.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Background:
- Peripheral artery disease (PAD) affects lower limb circulation.
- Atherosclerosis is a primary cause of PAD.
- Understanding the link between atherosclerosis burden and cardiovascular events is crucial.
Purpose of the Study:
- To investigate the relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs).
- To determine if the location and severity of atherosclerosis impact MACE risk.
Main Methods:
- Retrospective analysis of symptomatic PAD patients undergoing digital subtraction angiography (DSA).
- Categorization of atherosclerosis burden into aorto-iliac, femoropopliteal, or tibial segments.
- MACEs defined as cerebrovascular events, heart failure (HF), or myocardial infarction.
Main Results:
- Tibial vessel atherosclerosis strongly correlated with increased risk of HF (OR 3.9) and overall MACEs (OR 2.3).
- Increasing severity of tibial atherosclerosis directly elevated the risk for both HF and MACEs.
- Femoropopliteal atherosclerosis also increased HF (OR 2.3) and MACE risk (OR 1.9), with extent solely impacting MACE risk.
Conclusions:
- Severe tibial atherosclerosis in PAD patients is a significant predictor of MACEs.
- The risk of MACEs increases proportionally with the severity of tibial vessel atherosclerosis.
- While aortoiliac atherosclerosis showed no MACE association, femoropopliteal involvement increased MACE risk.
Objective:
The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs).
Methods:
All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system.
Results:
The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4-6.5) and for MACEs overall (OR 2.3; 95%CI 1.4-3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6-8.0 for HF and an OR 3.1; and 95%CI 1.7-5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6-3.2) and MACE (OR 1.9; 95%CI 1.3-2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs.
Conclusions:
PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased.
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