The Influence of Peripheral Arterial Disease on Outcomes

• Published in: Journal of the American College of Cardiology Vol. 48; no. 8; pp. 1567 - 1572
• Main Authors: Saw, Jacqueline, Bhatt, Deepak L., Moliterno, David J., Brener, Sorin J., Steinhubl, Steven R., Lincoff, A. Michael, Tcheng, James E., Harrington, Robert A., Simoons, Maarten, Hu, TingFei, Sheikh, Mobeen A., Kereiakes, Dean J., Topol, Eric J.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 17-10-2006
• Subjects: TVR; PAD; OR; CI; CAD; PCI; HR; MI; GPIIb/IIIa
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2006.03.067

The Influence of Peripheral Arterial Disease on Outcomes: A Pooled Analysis of Mortality in Eight Large Randomized Percutaneous Coronary Intervention Trials
Jacqueline Saw, Deepak L. Bhatt, David J. Moliterno, Sorin J. Brener, Steven R. Steinhubl, A. Michael Lincoff, James E. Tcheng, Robert A. Harrington, Maarten Simoons, TingFei Hu, Mobeen A. Sheikh, Dean J. Kereiakes, Eric J. Topol
Patients undergoing percutaneous coronary intervention (PCI) frequently have concomitant peripheral arterial disease (PAD). We performed a pooled analysis of 8 randomized PCI trials (EPIC, EPILOG, EPISTENT, RAPPORT, CAPTURE, IMPACT-II, TARGET, and CREDO), evaluating short- and long-term clinical outcomes of PAD patients undergoing PCI. Patients with PAD had higher 7-day, 30-day, and 6-month death or myocardial infarction rates and 1-year mortality. With multivariable analyses, PAD remained an independent predictor of mortality at 30 days, 6 months, and 1 year.
We aimed to evaluate clinical outcomes among peripheral arterial disease (PAD) patients following percutaneous coronary intervention (PCI).
A significant proportion of patients with coronary artery disease undergoing PCI have concomitant PAD, which may be associated with worse outcomes.
We performed a pooled analysis of 8 randomized PCI trials. We included multicenter PCI trials that compared antiplatelet therapies (EPIC, EPILOG, EPISTENT, RAPPORT, CAPTURE, IMPACT-II, TARGET, and CREDO) and had baseline PAD status recorded. Multivariable analyses were performed with stepwise logistic regression for 7- and 30-day outcomes and Cox regression for 6-month and 1-year events.
In our pooled analysis of 19,867 patients undergoing PCI, 1,602 (8.1%) were previously diagnosed with PAD. Patients with PAD had higher incidences of 7-day death (1.0% vs. 0.4%; p < 0.001) or myocardial infarction (MI) (6.8% vs. 5.6%; p = 0.047), 30-day death (1.7% vs. 0.7%; p < 0.001) or MI (7.4% vs. 6.1%; p = 0.05), 6-month death (4.2% vs. 1.5%; p < 0.001) or MI (9.1%, vs. 7.7%; p = 0.048), and 1-year death (5.0% vs. 2.1%; p < 0.001). There was a trend toward higher major bleeding risk with PAD (4.8% vs. 3.9%; p = 0.06). With multivariable analyses, PAD remains a significant predictor of mortality at 30 days (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03 to 2.70; p = 0.039), 6 months (HR 1.76, 95% CI 1.31 to 2.37; p < 0.001), and 1 year (HR 1.46, 95% CI 1.08 to 1.96; p = 0.013).
The presence of PAD is associated with higher rates of post-PCI death and MI, and is an independent predictor of short- and long-term mortality.