Abstract 5793: Lower Extremity Peripheral Vascular Disease is an Independent Predictor of Adverse Outcomes After Percutaneous Coronary Intervention
Background: A significant proportion of patients with coronary artery disease have coexistent peripheral vascular disease (PVD). Whether PVD is a predictor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI) in the drug eluting stent era is not known.
Methods: Data was analysed from a total of 9110 patients from the Melbourne Intervention Group (MIG) database, a registry of patients undergoing PCI in Melbourne, Australia. Data was collected between April 2004 and July 2007 and analysed for baseline demographic data, traditional risk factors, procedural data and thirty day and twelve month major adverse cardiovascular events (MACE).
Results: Of the 9110 patients undergoing PCI, 632(6.9%) had PVD. Patients with PVD had an average age of 70.6 years, were more frequently diabetic (41.3% vs. 22.6%, p<0.01), were hypertensive (79.7% v 63.1%, p<0.01), and had higher lipid levels (82.5% v 70.6%). In the PVD group patients were more likely to have left main (2.4% vs. 0.7%, p<0.01) and ostial lesions(5.1% vs 3.4%, p=0.02) with no difference in acute procedural success between the 2 groups. 30 day MACE was higher in the PVD group (8.1% vs. 5% p<0.01) with a significant increase in early mortality. 12 month MACE was also more frequent in the PVD group (21% vs. 12.4%, p<0.01), with increased 12 month MI (9.8% vs. 4.3%, p<0.01) and mortality (8.6%v 3.5% p<0.01). On multivariate analysis, PVD independently increased the risk of 12 month MACE (OR 1.456, CI 1.07–1.99 p<0.01).
Conclusions: PVD is an independent predictor of adverse outcomes in patients undergoing PCI even correcting for traditional risk factors. In this study we found a significant increase in 30 day and 12 month mortality and MI in the PVD group, with diabetes and hypertension the most critical modifiable risk factors. Thus in patients undergoing PCI, the presence of peripheral vascular disease should be recognised as an additional factor in determining risk of cardiac events in the short and long term post PCI, with tighter diabetic control and lower blood pressure to be the primary targets of medical therapy in this group.