Impact of routine coronary catheterization in low extremity artery disease undergoing percutaneous transluminal angioplasty: study protocol for a multi-center randomized controlled trial

Abstract

BackgroundThe prevalence of significant obstructive coronary artery disease with complex lesions is high in patients who have low extremity artery disease (LEAD). However, intermediate- or long-term cardiovascular prognosis of LEAD patients undergoing percutaneous transluminal angioplasty (PTA) remains poor. Accordingly, prophylactic coronary revascularization may modify short- and long-term cardiovascular outcomes of LEAD patients receiving PTA. Because myocardial ischemic symptoms are often masked in LEAD and the accuracy of non-invasive stress tests is usually limited, a high-quality randomized controlled trial aimed at the investigation of the prognostic role of coronary evaluation strategies before PTA is warranted.Methods/DesignThe proposed study is designed as a prospective, multi-center, open-label, superiority, randomized controlled trial. The study is conducted in high-volume centers for PTA and coronary revascularization in Taiwan. To meet the inclusion criteria, the patients must be at least 20 years old, have known LEAD, and have been admitted for elective PTA. We plan to enroll 450 participants who are randomly allocated to a routine group (routine coronary angiography without a previous non-invasive stress test before PTA) and a selective group (selective coronary angiography based on the results of non-invasive stress tests before PTA) with 1:1 ratio. Besides, we expect to enroll about 250 additional participants, who are not willing to be randomly assigned, in the registration group. The choice of revascularization procedure depends on the operator’s or cardiovascular team’s suggestion and the patient’s decision. Clinical follow-up will be performed 30 days after PTA and every 6 months until the end of the 1-year follow-up for the last randomly assigned participant. The primary endpoint is the composite major adverse cardiac event on long-term follow-up. Pre-specified secondary and other endpoints are also evaluated. Those assessing biomarkers and clinical endpoints are all blinded after assignment to interventions.DiscussionThe results of the trial will, for the first time, support better decision-making for coronary evaluation before PTA in LEAD. If favorable, routine coronary angiography followed by revascularization will improve cardiovascular outcomes in LEAD patients undergoing PTA.Trial registrationClinicalTrials.gov identifier: NCT02169258 (registered on 21 June 2014); registry name: Routine Coronary Catheterization in Low Extremity Artery Disease Undergoing Percutaneous Transluminal Angioplasty (PIROUETTE-PTA).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1237-0) contains supplementary material, which is available to authorized users.

Plasma Levels of Proprotein Convertase Subtilisin/Kexin Type 9 Are Elevated in Patients With Peripheral Artery Disease and Associated With Metabolic Disorders and Dysfunction in Circulating Progenitor Cells

“…PCSK9 has been shown to be associated with inflammation because plasma PCSK9 levels are correlated with fibrinogen levels, white blood cell count, the severity of coronary stenosis, and carotid intima–media thickness in CAD patients . PAD shares common pathogenesis mechanisms of atherosclerosis with CAD, and patients with PAD have a higher prevalence of concomitant CAD . Taken together, the concentration of PCSK9 in plasma is presumed to be higher in patients with PAD.…”

Computer-assisted prediction of atherosclerotic intimal thickness based on weight of adrenal gland, interleukin-6 concentration, and neural networks

“…To further verify the scientific and extrapolated nature of the model, a prospective multicenter controlled study should be conducted among a wide range of community populations to verify and improve the prediction model. 43,44…”

Long-term outcomes of peripheral arterial disease patients with significant coronary artery disease undergoing percutaneous coronary intervention

“…Our study is a registered observational study and may be a limitation of analysis. As Chen and colleagues' research results come out, the results will be updated a bit (18).…”

“…Therefore, evaluating the presence of CAD, which can lead to coronary revascularization and optimal medical treatment, can improve both short- and long-term surviaval in patients receiving PTA [ 8 , 16 , 17 ]. However, the effective of routine evaluation of coronary arteries in patients receiving PTA is unclear [ 11 , 18 ]. In the present study, we evaluated the long-term clinical outcomes of the strategy of routine coronary angiography (CAG) and subsequent percutaneous coronary intervention (PCI) in patients with PAD who underwent PTA.…”