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Coronary artery disease is highly prevalent among patients with premature peripheral vascular disease
R J Valentine1, P A Grayburn, E J Eichhorn
1Department of Surgery, Dallas Veterans Administration Medical Center, TX.
Insights
Premature peripheral vascular disease in male veterans is strongly linked to coronary artery disease (CAD). Early detection of CAD is crucial due to frequent cardiac complications in this population.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Premature peripheral vascular disease (PVD) often indicates underlying systemic atherosclerosis.
- Coronary artery disease (CAD) is a significant concern in patients presenting with early-onset PVD.
Purpose of the Study:
- To determine the prevalence of CAD in male military veterans with symptomatic premature PVD.
- To document associated cardiac complications in this patient cohort.
Main Methods:
- Studied 59 male veterans with premature PVD (onset <= 45 years) affecting the lower extremities.
- Utilized exercise stress testing and coronary angiography to assess for CAD.
- Coronary angiography was performed for patients unable to exercise or with abnormal stress test results.
Main Results:
- 71% of patients had significant CAD (>= 50% lesion) confirmed by coronary catheterization.
- Cardiac complications were frequent, including high rates of myocardial infarction and prior revascularization procedures (CABG/PTCA).
- Five deaths occurred during the study, primarily from myocardial infarction and stroke.
Conclusions:
- Premature peripheral atherosclerosis is a strong indicator of high prevalence of coronary artery disease.
- Screening for CAD is essential in patients with premature PVD to mitigate frequent and severe cardiac events.
Purpose:
This study was designed to document the prevalence of coronary artery disease (CAD) and associated cardiac complications among patients with symptoms of premature peripheral vascular disease.
Methods:
We studied the peripheral and coronary arterial circulations of 59 consecutive male military veterans diagnosed with premature peripheral vascular disease (age of onset < or = 45 years) affecting the lower extremity. Patients who had not previously undergone coronary angiography underwent exercise stress testing. Patients unable to perform exercise testing and those with abnormal exercise test results underwent coronary angiography.
Results:
There was no evidence of CAD in 16 patients (29%) on the basis of normal exercise test results (n = 12) or normal coronary angiography results (n = 4). Forty-three patients (71%) had significant (> or = 50% lesion) CAD by coronary catheterization. Cardiac complications were frequent among the 43 patients. Eleven (65%) of the 17 patients with single-vessel CAD had previously documented myocardial infarctions, as did three (75%) of the four patients with two-vessel CAD and 18 (82%) of the 22 patients with three vessel or greater CAD. Three (18%) patients with one-vessel CAD had undergone coronary artery bypass grafting or percutaneous transluminal coronary angioplasty for symptoms, as had one patient (25%) with two-vessel CAD and 19 patients (86%) with three-vessel or greater CAD. Five patients died during the study period, four of myocardial infarction and one of stroke.
Conclusions:
Premature peripheral atherosclerosis is associated with a high prevalence of CAD. Detection of CAD is important in this group, because cardiac complications are frequent.