1. Long-Term Comparative Outcomes of Patients With Peripheral Artery Disease With and Without Concomitant Coronary Artery Disease
Debbie C. Chen1, Gagan D. Singh MD1, Ehrin J. Armstrong MD MSc MAS2, Stephen W. Waldo MD2, John R. Laird MD1, Ezra A. Amsterdam MD1
1 University of California, Davis Vascular Center ; 2 University of Colorado, Division of Cardiology and VA Eastern Colorado Healthcare System, Denver, CO
BACKGROUND
RESULTS
CONCLUSIONS
Patients with PAD have the same or higher risk of major adverse cardiovascular events (MACE) and mortality as patients with coronary artery disease (CAD).1,2
Patients with PAD are less likely than patients with CAD to receive optimal guideline-directed medical therapy (GDMT), including aspirin, angiotensin-converting enzyme inhibitors (ACEI), and statins.3
There are little contemporary data describing long-term outcomes among high-risk, symptomatic PAD patients with or without concomitant CAD.4
Compared to patients with PAD only, patients with CAD + PAD had:
More baseline comorbidities
Higher rates of GDMT use
Despite receiving more optimal GDMT, PAD patients with concomitant CAD had significantly higher rates of 5-year all-cause mortality.
The subgroup of CLI patients with concomitant CAD was at particularly high risk for both MACE and all-cause mortality.
METHODS
LIMITATIONS
Study Design and Data Sources
Retrospective cohort study utilizing the University of California, Davis, PAD Registry, which comprises all patients with a clinical diagnosis of who underwent diagnostic and/or therapeutic endovascular intervention at UCDMC between 2006 and 2013.
EMR chart review: 330 data elements/patient were obtained, including:
Baseline demographics
Pre-procedure and 2-year GDMT use
Laboratory and procedural data
Clinical outcomes
Study Population
All 879 patients in the registry had PAD defined by:
Critical limb ischemia (CLI)
Intermittent Claudication (IC)
Specific Aims
Determine how the presence of CAD affects 5-year mortality and MACE.
Determine how the presence of CAD affects the use of GDMT among patients with symptomatic PAD.
Single center, retrospective study
Unable to fully assess reasons for not prescribing GDMT
Causes of mortality unknown
REFERENCES
Characteristics of CAD Patients (N=456)
History of MI (%)
206 (45)
History of PCI (%)
157 (34)
History of CABG (%)
204 (45)
History of coronary revascularization (%)
361 (80)
1. Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to Circulation. 2011; 124:17–23.
2. Welten GMJM, Schouten O, Hoeks SE, et al. Long-term prognosis of patients with peripheral arterial disease: a comparison in patients with coronary artery disease. J Am Coll Cardiol. 2008;51:1588–1596.
3. Subherwal S, Patel MR, Kober L, et al. Missed opportunities: Despite improvement in use of cardioprotective medications among patients with lower-extremity peripheral artery disease, underuse remains. Circulation. 2012;126:
4. Suarez C, Zeymer U, Limbourg T, et al. Influence of polyvascular disease on cardiovascular event rates. Insights from the REACH Registry. Vasc Med. 2010; 15(4)
ACKNOWLEDGEMENTS AND DISCLOSURES
We thank the UC Davis School of Medicine Medical Student Research Program for their support of this senior Scholarly Project Option (SPO)
John Laird reports being a consultant for Boston Scientific, Covidien, Abbott, Bard, and Medtronic. Ehrin Armstrong reports being a consultant for Abbott Vascular, Medtronic, Merck, and Spectranetics. Ezra A. Amsterdam is on the Advisory Board of Astra Zeneca. All other authors report no conflicts of interest related to this study.