冠心病患者中既往未被识别的外周动脉疾病的患病率及预测：介入治疗患者外周动脉疾病研究

Prevalence and prediction of previously unrecognized peripheral arterial disease in patients with coronary artery disease: the Peripheral Arterial Disease in Interventional Patients Study.

作者信息

Moussa Issam D, Jaff Michael R, Mehran Roxana, Gray William, Dangas George, Lazic Zoran, Moses Jeffery W

机构信息

Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical Center, Weill Medical College of Cornell University, New York, New York, USA.

出版信息

Catheter Cardiovasc Interv. 2009 May 1;73(6):719-24. doi: 10.1002/ccd.21969.

DOI:10.1002/ccd.21969

PMID:19213068

Abstract

BACKGROUND

Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown.

OBJECTIVE

To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiography and/or intervention and to determine the relationship between presence of PAD and severity of CAD.

METHODS

The Peripheral Arterial Disease in Interventional Patients Study (PIPS) is a prospective cohort study conducted at an inpatient service of a tertiary referral center. A total of 800 patients referred for coronary angiography without prior diagnosis of PAD aged 70 years or older or aged 50-69 years with a history of tobacco use and/or diabetes mellitus were included. Evaluation involved a medical history, a questionnaire to assess symptoms and functional status, and measurement of the ankle-brachial index (ABI). PAD was considered present if the ABI was 0.90 or less.

RESULTS

The prevalence of previously unrecognized PAD was 15%, 95% CI (12.6-17.7) and was highest among patients over 70 years of age (25.2%) and in women (23.3%). Among patients with CAD, those with PAD had higher prevalence of left main and multivessel coronary artery disease (87.2% vs. 75.5%, P = 0.006). Alternatively, patients with multivessel CAD had a twofold higher risk of being diagnosed with previously unrecognized PAD compared with those with single vessel CAD [adjusted OR = 2.02, (95% CI 1.03-3.98)].

CONCLUSIONS

PAD is often overlooked even in patients with known ischemic heart disease under specialist cardiovascular care. Overlooked PAD in this population increases in frequency with advanced age, in women, and in the presence of other traditional cardiovascular risk factors. Furthermore, the presence of PAD in this population identifies a subgroup with more severe form of CAD.

摘要

背景

外周动脉疾病（PAD）在基层医疗实践中诊断不足，但冠状动脉疾病（CAD）患者中未被识别的PAD程度尚不清楚。

目的

评估接受冠状动脉造影和/或介入治疗的患者中先前未被识别的PAD患病率，并确定PAD的存在与CAD严重程度之间的关系。

方法

介入患者外周动脉疾病研究（PIPS）是在一家三级转诊中心的住院服务部门进行的一项前瞻性队列研究。纳入了800例年龄在70岁及以上或50 - 69岁且有吸烟史和/或糖尿病史、未经PAD先前诊断而转诊进行冠状动脉造影的患者。评估包括病史、评估症状和功能状态的问卷以及踝臂指数（ABI）测量。如果ABI为0.90或更低，则认为存在PAD。

结果

先前未被识别的PAD患病率为15%，95%可信区间（12.6 - 17.7），在70岁以上患者中最高（25.2%），在女性中也较高（23.3%）。在CAD患者中，患有PAD的患者左主干和多支冠状动脉疾病的患病率更高（87.2%对75.5%，P = 0.006）。另外，与单支血管CAD患者相比，多支血管CAD患者被诊断为先前未被识别的PAD的风险高出两倍[调整后的比值比 = 2.02，（95%可信区间1.03 - 3.98）]。