Cardiovascular Research Institute, Korea University, Seoul, Korea.
Division of Cardiology, Nowon Eulji Hospital, Eulji University, Seoul, Korea.
PLoS One. 2021 May 19;16(5):e0251542. doi: 10.1371/journal.pone.0251542. eCollection 2021.
Patients with peripheral arterial disease (PAD) have known to a high risk of cardiac mortality. However, the effectiveness of the routine evaluation of coronary arteries such as routine coronary angiography (CAG) in PAD patients receiving percutaneous transluminal angioplasty (PTA) is unclear.
A total of 765 consecutive PAD patients underwent successful PTA and 674 patients (88.1%) underwent routine CAG. Coronary artery disease (CAD) was defined as angiographic stenosis ≥70%. Patients were divided into three groups; 1) routine CAG and a presence of CAD (n = 413 patients), 2) routine CAG and no CAD group (n = 261 patients), and 3) no CAG group (n = 91 patients). To adjust for any potential confounders that could cause bias, multivariable Cox-proportional hazards regression and propensity score matching (PSM) analysis was performed. Clinical outcomes were evaluated by Kaplan-Meier curved analysis at 5-year follow-up.
In this study, the 5-year survival rate of patients with PAD who underwent PTA was 88.5%. Survival rates were similar among the CAD group, the no CAD group, and the no CAG group, respectively (87.7% vs. 90.4% vs. 86.8% P = 0.241). After PSM analysis between the CAD group and the no CAD group, during the 5-year clinical follow-up, there were no differences in the incidence of death, myocardial infarction, strokes, peripheral revascularization, or target extremity surgeries between the two groups except for repeat PCI, which was higher in the CAD group than the non-CAD group (9.3% vs. 0.8%, P<0.001).
PAD patients with CAD were expected to have very poor long-term survival, but they are shown no different long-term prognosis such as mortality compared to PAD patients without CAD. These PAD patients with CAD had received PCI and/or optimal medication treatment after the CAG. Therefore a strategy of routine CAG and subsequent PCI, if required, appears to be a reasonable strategy for mortality risk reduction of PAD patients. Our results highlight the importance for evaluation for CAD in patients with PAD.
患有外周动脉疾病（PAD）的患者已知存在较高的心脏死亡率风险。然而，在接受经皮腔内血管成形术（PTA）的 PAD 患者中，常规评估冠状动脉（如常规冠状动脉造影术 [CAG]）的有效性尚不清楚。
共纳入 765 例连续成功接受 PTA 的 PAD 患者，其中 674 例（88.1%）患者接受了常规 CAG。冠状动脉疾病（CAD）定义为血管造影狭窄≥70%。患者被分为三组；1）常规 CAG 且存在 CAD（n=413 例），2）常规 CAG 且无 CAD 组（n=261 例）和 3）无 CAG 组（n=91 例）。为了调整可能导致偏倚的任何潜在混杂因素，进行了多变量 Cox 比例风险回归和倾向评分匹配（PSM）分析。通过 Kaplan-Meier 曲线分析在 5 年随访时评估临床结局。
在这项研究中，接受 PTA 的 PAD 患者的 5 年生存率为 88.5%。CAD 组、无 CAD 组和无 CAG 组的生存率分别相似（87.7% vs. 90.4% vs. 86.8%，P=0.241）。在 CAD 组和无 CAD 组之间进行 PSM 分析后，在 5 年临床随访期间，两组之间的死亡率、心肌梗死、卒中等、外周血运重建或靶肢手术发生率均无差异，除 CAD 组再次接受 PCI 的发生率高于无 CAD 组（9.3% vs. 0.8%，P<0.001）。
患有 CAD 的 PAD 患者预期会有非常差的长期生存率，但与无 CAD 的 PAD 患者相比，他们的长期预后（如死亡率）没有差异。这些患有 CAD 的 PAD 患者在 CAG 后接受了 PCI 和/或最佳药物治疗。因此，常规 CAG 及必要时的 PCI 的策略似乎是降低 PAD 患者死亡率的合理策略。我们的研究结果强调了在 PAD 患者中评估 CAD 的重要性。
