Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

Abstract

Objectives To evaluate the clinical characteristics and outcomes of patients with peripheral vascular disease (PVD) undergoing percutaneous coronary intervention (PCI) in a contemporary setting, and to determine whether use of drug‐eluting stents (DESs) improves outcomes. Background PVD was an independent risk factor for adverse outcomes following PCI in the bare‐metal stent (BMS) era. It is not known whether outcomes in these patients have improved with advances in interventional techniques and stent technology, as they have for the general population. Methods Eighteen thousand three hundred and eighty patients undergoing PCI from an Australian registry between 2005 and 2013 were studied. Clinical and procedural data, 30‐day and 12‐month outcomes were compared in those with and without a reported history of PVD. Outcomes were also compared between patients with PVD who received DES and those who received BMS. Long‐term mortality was compared using Australian National Death Index (NDI) linkage. Results Patients with PVD (n = 1,251, 6.8%) were older and had more prevalent diabetes, hypertension, cerebrovascular disease, heart failure, renal impairment, ostial lesions, left main, and multi‐vessel disease (p < 0.001). Patients with PVD had significantly higher rates of major adverse cardiovascular events (MACEs) compared with those without PVD, in‐hospital (5.7% vs. 4.1%, p < 0.008), at 30‐days (8.6% vs. 5.8%, p < 0.001) and at 12‐months (24.6% vs. 13.2%, p < 0.001). At 4.9 ± 2.6 years follow‐up, there was significantly greater mortality in the PVD group. PVD patients who received DES experienced significantly less MACE than PVD patients treated with BMS at 30‐days (4.8 vs. 10.1%, p < 0.001) and 12‐months (19.4 vs. 26.4%, p < 0.005). Conclusions PVD is an independent predictor of adverse outcomes in patients undergoing PCI. PVD patient who received DES had improved outcomes compared with those receiving BMS.

Impact of peripheral artery disease on prognosis after percutaneous coronary intervention: Outcomes from the multicenter prospective e-ULTIMASTER registry

“…Previous studies reported PAD to be present in 5-20% of patients undergoing PCI [6,7,17]. The rate of 6.7% found in our study is within the previously reported range, however, the reported rate of PAD is relatively low.…”

“…Meta analyses of eight randomized PCI trials, found an almost 50% increased 1-year mortality risk independently associated with PAD [19]. Compared with BMS, patients with PAD treated with DES had better cardiovascular outcomes (yet still increased risk of 1-year cardiac death, MI and TVR compared to patients without PAD treated with DES) [7]. Other data from the first-generation DES era reports conflicting outcomes.…”

“…The presence of PAD not only indicates an increased risk for CAD, but is also associated with worse clinical outcomes in patients with myocardial infarction (MI) [4,5] and percutaneous coronary intervention (PCI) [6]. Patients with PAD treated with PCI are more likely to develop contrast-induced nephropathy and have an increased risk of adverse cardiovascular events, bleeding, and mortality [6][7][8][9][10][11].…”

Successful modeling of long term outcomes in end‐stage renal disease patients undergoing percutaneous coronary intervention with drug‐eluting stents

“…Our study found an association between the following factors and increased risk of long‐term mortality: higher age, higher baseline SYNTAX score, non‐use of statins at baseline, insulin‐dependent diabetes, COPD, peripheral vascular occlusive disease, and lower baseline platelet count. Peripheral vascular occlusive disease has previously been identified as a risk factor for poor long‐term outcomes after PCI in general 25,26 . Moreover, the conclusion that higher baseline SYNTAX score is associated with long‐term mortality among patients with ESRD is consistent with a study performed by Tomaszuk‐Kazberuk et al validating the prognostic tool among dialysis‐dependent patients 27 .…”

Predictive value of ACEF II score in patients with multi-vessel coronary artery disease undergoing one-stop hybrid coronary revascularization

“…Further, due to the diffuse nature of the atherosclerotic process, patients with MVCAD are often complicated with PVD. Previous studies have shown that PVD is an independent predictor of adverse outcomes and poorer survival after CABG and PCI [ 25 , 26 ]. Although not statistically significant after multivariate adjustment analysis, there was still an association between PVD and poor prognosis.…”