Vascular Disease Burden and In-Hospital Outcomes Among Patients Undergoing Percutaneous Coronary Intervention in New York State

Abstract

Background— The presence of atherosclerosis in extracardiac vascular beds is associated with an increased risk of adverse cardiovascular outcomes among stable patients with coronary artery disease (CAD). However, there is little data regarding the impact of the presence and extent of vascular disease on outcomes in patients with CAD undergoing percutaneous coronary intervention. Methods and Results— We analyzed 69 045 consecutive patients from the New York State Coronary Angioplasty Reporting System database who underwent percutaneous coronary intervention between 1998 and 1999. Vascular disease burden was assessed by history of aortoiliac, femoral-popliteal, and carotid disease. Patients were stratified into 3 groups: CAD alone, CAD and 1 additional site, and CAD and 2 or 3 additional sites. A logistic regression model was constructed to determine the relation between vascular disease burden and in-hospital mortality. Any history of vascular disease was present in 5915 (8.6%) of the population, of whom 4840 (82%) had CAD and 1 other disease location and 1075 (18%) had CAD and 2 or 3 other disease locations. There was a significant relationship between the number of disease locations and hospital mortality, ranging from 0.7% in patients with CAD alone to 2.0% and 2.6% for patients with 1 or ≥2 disease locations, respectively ( P <0.001). In unadjusted analysis, in-hospital mortality was ≈3-fold higher (odds ratio, 2.89; 95% CI, 2.31 to 3.60; P <0.001) and 4-fold higher (odds ratio, 3.78; 95% CI, 2.57 to 5.56; P <0.001) for inpatients with CAD and additional vascular disease at 1 site and ≥2 sites, respectively. After multivariable adjustment, each additional vascular bed affected was associated with a 50% increase in in-hospital mortality (odds ratio, 1.50; 95% CI, 1.27 to 1.78; P <0.001). Conclusions— Among patients with CAD undergoing percutaneous coronary intervention, vascular disease burden is associated with higher rates of adverse events and is an independent predictor of in-hospital mortality.

Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention

“…Several studies in the BMS era concluded that PVD was an independent predictor of adverse outcomes after PCI . Nikolsky et al examined 12‐month outcomes in 10,440 consecutive patients undergoing PCI in the BMS era, 1,969 of whom had symptomatic lower extremity PVD.…”

“…Despite a reduction in the rate of repeat PCI, their risk of major adverse cardiovascular events (MACEs) outcomes following PCI has remained unchanged across the early bare‐metal stent (BMS) and drug‐eluting stent (DES) eras . While PVD is recognized as an independent predictor of poor outcomes after PCI in the BMS era, there is a paucity of data within the DES era . This study aimed to evaluate whether PVD is an independent predictor of adverse outcomes in patients undergoing PCI in a contemporary setting.…”

Peripheral artery disease, biomarkers, and darapladib

“…8 In particular, polyvascular disease that includes atherosclerosis of multiple vascular beds is associated with higher risk of recurrent ischemic events and warrants special attention. 9–11 To address these issues, we evaluated a panel of inflammatory, platelet, and lipid biomarkers as independent predictors of symptomatic PAD in a cohort of patients with coronary disease or their risk equivalent receiving atorvastatin who were randomized to receive darapladib or placebo. 12 Darapladib is a selective lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) inhibitor that is under investigation for its potential to stabilize high-risk atherosclerotic plaques and potentially reduce cardiovascular events.…”

Impact of incomplete revascularization in patients undergoing PCI for unprotected left main stem stenosis

“…Completeness of revascularization by PCI is often limited by the chance of technical success in treating adverse lesions such as chronic occlusions. Patients in whom complete revascularization is most difficult are often those at highest risk, because complex coronary anatomy is frequently associated with clinical risk factors such as age, diabetes, renal impairment, and extra‐cardiac arteriopathy . Many of these patients are therefore also not fit to undergo CABG.…”