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

There are limited contemporary data on guideline-directed medical therapy (GDMT) utilization and long-term clinical outcomes in patients with peripheral artery disease (PAD) with and without concomitant coronary artery disease (CAD). From 2006 to 2013, 879 patients with claudication or critical limb...

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Bibliographic Details
Published in:The American journal of cardiology Vol. 119; no. 8; pp. 1146 - 1152
Main Authors: Chen, Debbie C., Singh, Gagan D., Armstrong, Ehrin J., Waldo, Stephen W., Laird, John R., Amsterdam, Ezra A.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 15.04.2017
Elsevier Limited
Subjects:
Adrenergic beta-Antagonists - therapeutic use
Age
Aged
Amputation
Angiography
Angiotensin-converting enzyme inhibitors
Ankle
Aspirin
Aspirin - therapeutic use
California - epidemiology
Cardiovascular
Cardiovascular disease
Cardiovascular diseases
Cardiovascular system
Catheterization
Cerebral infarction
Cerebrovascular system
Classification
Clinical outcomes
Clinical trials
Collaboration
Computer programs
Congestive heart failure
Coronary artery
Coronary artery disease
Coronary Artery Disease - drug therapy
Coronary Artery Disease - mortality
Coronary vessels
Data processing
Death
Diabetes Mellitus - epidemiology
Disease prevention
Documentation
Enzymes
Female
Follow-Up Studies
Health risk assessment
Heart attacks
Heart Failure
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypertension - epidemiology
Ischemia
Kidney diseases
Kidney Failure, Chronic - epidemiology
Male
Mortality
Myocardial Infarction - epidemiology
Myocardial Revascularization - statistics & numerical data
Pain
Patients
Peptidyl-dipeptidase A
Peripheral Arterial Disease - drug therapy
Peripheral Arterial Disease - mortality
Pharmacy
Platelet Aggregation Inhibitors - therapeutic use
Proportional Hazards Models
Retrospective Studies
Risk Factors
Sensitivity analysis
Sex Factors
Stroke
Subgroups
ISSN:0002-9149, 1879-1913
Online Access:Get full text
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Summary:There are limited contemporary data on guideline-directed medical therapy (GDMT) utilization and long-term clinical outcomes in patients with peripheral artery disease (PAD) with and without concomitant coronary artery disease (CAD). From 2006 to 2013, 879 patients with claudication or critical limb ischemia (CLI) underwent diagnostic angiography or therapeutic endovascular intervention at our multidisciplinary vascular center. GDMT use was assessed at the time of angiography, and major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality were determined during 5 years of follow-up. Cox proportional hazard modeling was used to adjust for baseline differences between patients with and without concomitant CAD. Despite a higher adherence to GDMT (all p ≤0.002) for the use of aspirin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statins, patients with PAD and concomitant CAD had higher unadjusted 5-year rates of MACCE (hazard ratio [HR] 1.7, 95% CI 1.3 to 2.1, p = 0.0001) and all-cause mortality (HR 1.86, 95% CI 1.4 to 2.4, p = 0.0001). After adjustment for baseline co-morbidities, the presence of CAD remained an independent risk factor for mortality (adjusted HR 1.35, 95% CI 1.02 to 1.80, p = 0.04) but not for MACCE (adjusted HR 1.24, 95% CI 0.96 to 1.60, p = 0.10) in patients with PAD. A sensitivity analysis limited to patients with CLI demonstrated that concomitant CAD was associated with significantly higher adjusted rates of both MACCE (adjusted HR 1.52, 95% CI 1.14 to 2.03, p = 0.01) and mortality (adjusted HR 1.64, 95% CI 1.12 to 2.20, p = 0.006). In conclusion, despite higher rates of GDMT use, PAD patients with concomitant CAD had significantly increased risk of all-cause mortality during a 5-year postprocedural follow-up. The subgroup of CLI patients with concomitant CAD was at particularly high risk for both MACCE and all-cause mortality.
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ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2016.12.023