The Japanese Association of Cardiovascular Intervention and Therapeutics, 2-20-8, Shinkawa, Chuo-ku, Tokyo, 104-0033, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Cardiovasc Diabetol. 2019 Nov 15;18(1):155. doi: 10.1186/s12933-019-0955-5.
Lower-extremity peripheral artery disease (LE-PAD) and coronary artery disease (CAD) are both pathologically rooted in atherosclerosis, and their shared clinical features regarding the exposure to cardiovascular risk factors have been emphasized. However, comparative data of the two cardiovascular diseases (CVDs) were so far lacking. The purpose of this study was to directly compare the clinical profile between cases undergoing endovascular therapy (EVT) for LE-PAD and those undergoing percutaneous coronary intervention (PCI).
Data were extracted from the nationwide procedural databases of EVT and PCI in Japan (J-EVT and J-PCI) between 2012 and 2017. A total of 1,121,359 cases (103,887 EVT cases for critical limb ischemia [CLI] or intermittent claudication and 1,017,472 PCI cases for acute coronary syndrome [ACS] or stable angina) were analyzed. Heterogeneity in clinical profile between CVDs was evaluated using the C statistic of the logistic regression model for which dependent variable was one CVD versus another, and explanatory variables were clinical profile. When two CVDs were completely discriminated from each other by the developed model, the C statistic (discrimination ability) of the model would be equal to 1, indicating that the two CVDs were completely different in clinical profile. On the other hand, when two CVDs were identical in clinical profile, the developed model would not discriminate them at all, with the C statistic equal to 0.5.
Mean age was 73.5 ± 9.3 years in LE-PAD patients versus 70.0 ± 11.2 years in CAD patients (P < 0.001). The prevalence of diabetes mellitus and end-stage renal disease was 1.96- and 6.39-times higher in LE-PAD patients than in CAD patients (both P < 0.001). The higher prevalence was observed irrespective of age group. The exposure to other cardiovascular risk factors and the likelihood of cardiovascular risk clustering also varied between the diseases. The between-disease heterogeneity in patient profile was particularly evident between CLI and ACS, with the C statistic equal to 0.833 (95% CI 0.831-0.836).
The current study, an analysis based on nationwide procedural databases, confirmed that patient profiles were not identical but rather considerably different between clinically significant LE-PAD and CAD warranting revascularization.
下肢外周动脉疾病（LE-PAD）和冠状动脉疾病（CAD）在病理上均源于动脉粥样硬化，且其暴露于心血管危险因素的临床特征也已得到强调。然而，目前尚缺乏这两种心血管疾病（CVDs）的对比数据。本研究旨在直接比较接受下肢血管腔内治疗（EVT）的 LE-PAD 患者和接受经皮冠状动脉介入治疗（PCI）的患者的临床特征。
从 2012 年至 2017 年，从日本的 EVT（J-EVT）和 PCI（J-PCI）全国性程序数据库中提取数据。共分析了 1121359 例患者（CLI 或间歇性跛行患者中 103887 例行 EVT，ACS 或稳定型心绞痛患者中 1017472 例行 PCI）。采用逻辑回归模型的 C 统计量评估 CVD 之间的临床特征差异，因变量为一种 CVD 与另一种 CVD，解释变量为临床特征。当开发的模型完全区分两种 CVD 时，模型的 C 统计量（区分能力）将等于 1，表明两种 CVD 在临床特征上完全不同。另一方面，当两种 CVD 的临床特征完全相同时，开发的模型将无法区分它们，C 统计量等于 0.5。
LE-PAD 患者的平均年龄为 73.5±9.3 岁，CAD 患者为 70.0±11.2 岁（P<0.001）。LE-PAD 患者的糖尿病和终末期肾病患病率分别为 CAD 患者的 1.96 倍和 6.39 倍（均 P<0.001）。无论年龄组如何，患病率均较高。其他心血管危险因素的暴露情况和心血管风险聚集的可能性也在两种疾病之间有所不同。疾病之间患者特征的异质性在 CLI 和 ACS 之间尤为明显，C 统计量为 0.833（95%CI 0.831-0.836）。
本基于全国性程序数据库的分析研究证实，下肢血管腔内治疗的临床显著 LE-PAD 和 CAD 患者的患者特征并不相同，而是存在显著差异，这需要血运重建。
