Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention.

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.