Henkin Stanislav, McBane Robert D, Rooke Thom W, Wysokinski Waldemar E, Casanegra Ana I, Liedl David A, Wennberg Paul W
Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn.
J Vasc Surg. 2021 Oct;74(4):1335-1342.e2. doi: 10.1016/j.jvs.2021.03.041. Epub 2021 Apr 19.
The coexistence of coronary artery disease and peripheral artery disease (PAD) is well-established. Whether myocardial ischemia by electrocardiography during treadmill testing to evaluate PAD severity is associated with adverse cardiac and limb events has not been established. The aim of the current study is to assess the risk of major adverse cardiac events (MACE), major adverse limb events (MALE), and all-cause mortality in patients with evidence of myocardial ischemia on ECG compared with those without ischemia in patients undergoing treadmill testing for PAD evaluation.
Patients undergoing treadmill exercise ankle-brachial index (ABI) evaluation (January 1, 2003, to December 31, 2006) were identified using the Mayo Clinic Gonda Vascular Laboratory database. Patients with ischemia by electrocardiogram (ECG) were age and sex matched to patients without ischemia. Outcomes were compared by ECG category.
Of 4128 patients who underwent treadmill exercise, 170 (4.1%) had inducible myocardial ischemia by ECG. These were matched with 340 patients without ischemia. The positive ECG group had a higher percentage of diabetes mellitus (31.2% vs 21.8%; P = .02), carotid artery disease (22.4% vs 13.2%; P = .009), exercise-induced angina (14.1% vs 2.9%; P < .0001), and dyspnea (60.6% vs 35.6%; P < .0001). While the resting ABI was similar, the postexercise ABI was lower in the positive ECG group (0.5 vs 0.7; P = .04). After a median follow-up of 8 years, MACE were significantly greater in the positive ECG group (62.4% vs 46.5%; P < .001). MALE were significantly less frequent (17.1% vs 23.2%; P = .02), without an increased risk of amputation. In multivariable analysis, inducible ischemia was associated with higher incidence of MACE (hazard ratio, 1.65; 95% confidence interval, 1.25-2.16; P < .001) and lower incidence of MALE (hazard ratio, 0.51; 95% confidence interval, 0.31-0.84; P < .05).
ECG monitoring during vascular treadmill testing identified a subset of patients with more frequent MACE but less MALE.
冠状动脉疾病与外周动脉疾病（PAD）并存已得到充分证实。在评估PAD严重程度的平板运动试验期间，通过心电图检测到的心肌缺血是否与不良心脏和肢体事件相关尚未明确。本研究的目的是评估在进行平板运动试验以评估PAD的患者中，心电图显示有心肌缺血证据的患者与无缺血证据的患者相比，发生主要不良心脏事件（MACE）、主要不良肢体事件（MALE）和全因死亡的风险。
使用梅奥诊所贡达血管实验室数据库识别2003年1月1日至2006年12月31日期间接受平板运动踝臂指数（ABI）评估的患者。心电图显示有缺血的患者在年龄和性别上与无缺血的患者相匹配。根据心电图类别比较结果。
在4128例接受平板运动的患者中，170例（4.1%）通过心电图检测到可诱导的心肌缺血。这些患者与340例无缺血的患者相匹配。心电图阳性组糖尿病（31.2%对21.8%；P = 0.02）、颈动脉疾病（22.4%对13.2%；P = 0.009）、运动诱发心绞痛（14.1%对2.9%；P < 0.0001）和呼吸困难（60.6%对35.6%；P < 0.0001）的比例更高。虽然静息ABI相似，但心电图阳性组运动后ABI较低（0.5对0.7；P = 0.04）。中位随访8年后，心电图阳性组的MACE明显更多（62.4%对46.5%；P < 0.001）。MALE的发生频率明显较低（17.1%对23.2%；P = 0.02），截肢风险没有增加。在多变量分析中，可诱导的缺血与较高的MACE发生率（风险比，1.65；95%置信区间，1.25 - 2.16；P < 0.001）和较低的MALE发生率（风险比，0.51；95%置信区间，0.31 - 0.84；P < 0.05）相关。
血管平板运动试验期间的心电图监测识别出了一组MACE发生频率更高但MALE发生频率更低的患者。
