2012

DOI: 10.1161/cir.0b013e31823299a1

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2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

Mark A. Creager¹,

²

,

Edward I. Bluth

³

et al.

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Amount Of Sublingual Nitroglycerin Consumed1

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Cited by 58 publications

(38 citation statements)

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“…A confirmed diagnosis of PAD was based primarily on the type of PAD, based on reporting evidence of stenosis at the corresponding vasculature (Table 1). 11, 12, 13 All‐cause mortality was prospectively tracked over 5 years for all participants with medical chart review and confirmed by follow‐up contact and the Social Security Death Index. In this analysis, we included those with a documented history of PAD.…”

Section: Methodsmentioning

confidence: 99%

“…Peripheral artery disease is defined by American College of Cardiology/American Heart Association as a group of clinical disorders that includes abdominal aortic aneurysm, renal artery stenosis (RAS), mesenteric artery stenosis (MAS), and lower extremity peripheral artery disease (LEAD) 6, 12. However, The European Society of Cardiology uses the term PAD to include several vascular sites, including extracranial carotid artery stenosis (CAS) and vertebral artery diseases, upper extremity artery stenosis, MAS, RAS, and LEAD, but diseases of the aorta are not covered 13.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Trimethylamine N ‐Oxide and Mortality Risk in Patients With Peripheral Artery Disease

¹

,

²

,

³

et al. 2016

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BackgroundProduction of the proatherogenic metabolite, trimethylamine N‐oxide (TMAO), from dietary nutrients by intestinal microbiota enhances atherosclerosis development in animal models and is associated with atherosclerotic coronary artery disease in humans. The utility of studying plasma levels of TMAO to risk stratify in patients with peripheral artery disease (PAD) has not been reported.Methods and ResultsWe examined the relationship between fasting plasma TMAO and all‐cause mortality (5‐year), stratified by subtypes of PAD and presence of coronary artery disease in 935 patients with PAD who underwent elective angiography for cardiac evaluation at a tertiary care hospital. Median plasma TMAO was 4.8 μmol/L (interquartile range, 2.9–8.0 μmol/L). Elevated TMAO levels were associated with 2.7‐fold increased mortality risk (fourth versus first quartiles, hazard ratio 2.86, 95% CI 1.82–3.97, P<0.001). Following adjustments for traditional risk factors, inflammatory biomarkers, and history of coronary artery disease, the highest TMAO quartile remained predictive of 5‐year mortality (adjusted hazard ratio 2.06, 95% CI 1.36–3.11, P<0.001). Similar prognostic value for elevated TMAO was seen for subjects with carotid artery, non–carotid artery, or lower extremity PAD. TMAO provided incremental prognostic value for all‐cause mortality (net reclassification index, 40.22%; P<0.001) and improvement in area under receiver operator characteristic curve (65.7% versus 69.4%; P=0.013).Conclusions TMAO, a pro‐atherogenic metabolite formed by gut microbes, predicts long‐term adverse event risk and incremental prognostic value in patients with PAD. These findings point to the potential for TMAO to help improve selection of high‐risk PAD patients with or without significant coronary artery disease, who likely need more aggressive and specific dietary and pharmacologic therapy.

“…A confirmed diagnosis of PAD was based primarily on the type of PAD, based on reporting evidence of stenosis at the corresponding vasculature (Table 1). 11, 12, 13 All‐cause mortality was prospectively tracked over 5 years for all participants with medical chart review and confirmed by follow‐up contact and the Social Security Death Index. In this analysis, we included those with a documented history of PAD.…”

Section: Methodsmentioning

confidence: 99%

“…Peripheral artery disease is defined by American College of Cardiology/American Heart Association as a group of clinical disorders that includes abdominal aortic aneurysm, renal artery stenosis (RAS), mesenteric artery stenosis (MAS), and lower extremity peripheral artery disease (LEAD) 6, 12. However, The European Society of Cardiology uses the term PAD to include several vascular sites, including extracranial carotid artery stenosis (CAS) and vertebral artery diseases, upper extremity artery stenosis, MAS, RAS, and LEAD, but diseases of the aorta are not covered 13.…”

Section: Methodsmentioning

confidence: 99%

Trimethylamine N ‐Oxide and Mortality Risk in Patients With Peripheral Artery Disease

¹

,

²

,

³

et al. 2016

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BackgroundProduction of the proatherogenic metabolite, trimethylamine N‐oxide (TMAO), from dietary nutrients by intestinal microbiota enhances atherosclerosis development in animal models and is associated with atherosclerotic coronary artery disease in humans. The utility of studying plasma levels of TMAO to risk stratify in patients with peripheral artery disease (PAD) has not been reported.Methods and ResultsWe examined the relationship between fasting plasma TMAO and all‐cause mortality (5‐year), stratified by subtypes of PAD and presence of coronary artery disease in 935 patients with PAD who underwent elective angiography for cardiac evaluation at a tertiary care hospital. Median plasma TMAO was 4.8 μmol/L (interquartile range, 2.9–8.0 μmol/L). Elevated TMAO levels were associated with 2.7‐fold increased mortality risk (fourth versus first quartiles, hazard ratio 2.86, 95% CI 1.82–3.97, P<0.001). Following adjustments for traditional risk factors, inflammatory biomarkers, and history of coronary artery disease, the highest TMAO quartile remained predictive of 5‐year mortality (adjusted hazard ratio 2.06, 95% CI 1.36–3.11, P<0.001). Similar prognostic value for elevated TMAO was seen for subjects with carotid artery, non–carotid artery, or lower extremity PAD. TMAO provided incremental prognostic value for all‐cause mortality (net reclassification index, 40.22%; P<0.001) and improvement in area under receiver operator characteristic curve (65.7% versus 69.4%; P=0.013).Conclusions TMAO, a pro‐atherogenic metabolite formed by gut microbes, predicts long‐term adverse event risk and incremental prognostic value in patients with PAD. These findings point to the potential for TMAO to help improve selection of high‐risk PAD patients with or without significant coronary artery disease, who likely need more aggressive and specific dietary and pharmacologic therapy.

“…4 The definitions for peripheral arterial disease were taken from recent work by the Peripheral Atherosclerotic Vascular Disease Data Standards document. 32 The writing committee attempted to include only data elements that were pertinent to characterizing the risk of the patient. In addition, specific coding descriptors and detailed definitions have been provided so that medical abstractors should be able to code most of these data elements with information that is available as part of the standard process of documenting the delivery of care.…”

Section: Amount Of Sublingual Nitroglycerin Consumedmentioning

confidence: 99%

2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease

et al. 2013

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. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.

“…Remaining eligible subjects with an ABI >1.4 18 were excluded (n=26). Using these criteria, 1656 subjects were identified.…”

Section: Inclusion Criteriamentioning

confidence: 99%

Clinical and socioeconomic factors associated with unrecognized peripheral artery disease

¹

,

²

,

³

et al. 2014

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Peripheral artery disease (PAD) is a highly prevalent condition that frequently goes undetected and untreated. Socioeconomic factors associated with unrecognized PAD are not known. The ankle-brachial index (ABI) was calculated in 1656 study participants undergoing non-emergent coronary angiography with PAD defined as an ABI <0.9. Subjects were followed for mortality and cardiovascular outcomes. Compared to those without PAD, those with unrecognized PAD at enrollment were older, had higher rates of cardiovascular comorbidities, and had higher major adverse cardiovascular events (MACE) (p<0.03 for all). Among those enrolling without a reported history of PAD, there was a higher prevalence of PAD with decreasing income (p=0.004), education level (p<0.001), social isolation (p=0.027) and depression (p=0.034); 50% of these individuals reported symptoms suggestive of claudication. In conclusion, the prevalence of unrecognized PAD is high amongst a cohort of high-risk individuals referred for coronary angiography. A profile of lower socioeconomic status is associated with unrecognized PAD. These subjects will report symptoms suggestive of claudication and impaired walking ability when directly queried.

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