Abstract 14266: The Association Between Ischemic and Jeopardized Myocardia and All-Cause Mortality in Patients With Peripheral Artery Disease
OBJECTIVE: PAD is associated with increased all-cause mortality (ACM) and concomitant CAD. However, it is unclear whether uncovering the presence of coronary ischemia by a single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) would further help stratifying that excess risk.
Methods: From 01/2000 to 01/2009, 4,294 patients underwent cardiac stress testing within 180 days of ankle brachial index (ABI) exam. Of these, 645 had PAD and SPECT MPI stress testing. Abnormal ABI was defined as ≤ 0.9 or prior peripheral revascularization. Myocardial ischemic burden and total jeopardized myocardium were represented by summed difference score (SDS) and summed stress score (SSS), respectively. Cox proportional hazard analyses were used to study the impact of SDS and SSS on ACM. Additionally using a hierarchical approach, we examined the step-wise addition of post-stress test coronary and peripheral revascularizations as time-varying covariates on outcomes.
Results: Kaplan-Meier curves showed no significant differences in ACM between patients with ischemic myocardium (SDS > 0) and those without (SDS = 0), or between those with jeopardized myocardium (SSS > 0) and without (SSS = 0). Similarly in multivariable Cox analyses, the presence of ischemic or jeopardized myocardium remained with no significant impact on ACM in PAD, adjusted HR: 0.94, 95% CI: 0.53 - 1.69; P = 0.84 and adjusted HR: 1.16, 95% CI: 0.67 - 2.00; P = 0.59, respectively. Moreover, adjustment for post-testing coronary and peripheral revascularizations did not affect our results.
Conclusions: Ischemic and jeopardized myocardia are not predictors of ACM in PAD, thus SPECT MPI does not appear to be a useful risk stratification tool in these patients.
Unadjusted Comparison of All-Cause Mortality among PAD Patients according to the Presence of Ischemic Myocardium (Panel A) and Jeopardized Myocardium (Panel B)
Author Disclosures: T.A. Hammad: None. R. Yousefzai: None. S. Venkatachalam: None. A. Lowry: None. H.L. Gornik: None. W. Jaber: None. J.R. Bartholomew: None. S. Kim: None. M. Cerqueira: None. B.H. Gray: None. E.H. Blackstone: None. M.H. Shishehbor: None.
- © 2015 by American Heart Association, Inc.