Baviera Marta, Foresta Andreana, Fernandez Luisa Ojeda, Torrigiani Ginevra, Tettamanti Mauro, Roncaglioni Maria Carla, Cimminiello Claudio
Lab of Cardiovascular Prevention, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milano, Italy.
Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, Italy.
Intern Emerg Med. 2025 Jan;20(1):159-169. doi: 10.1007/s11739-024-03771-9. Epub 2024 Sep 30.
Peripheral artery disease (PAD) remains underdiagnosed in patients with coronary artery disease (CAD) and barriers persist to measure screening PAD in routine clinical practice. We assessed the prevalence of PAD in patients with CAD in Italian primary care setting using an easy automatic instrument to measure ankle brachial pressure index (ABI). A multicenter, observational study was conducted with 32 General Practitioners (GPs). Prevalence of PAD was calculated dividing the number of patients with abnormal ABI value, or with symptoms associated with PAD or history of lower limb revascularization procedures, over the total number of patients included in the study. Incidence of major CV clinical events and all-cause death was also evaluated at 12 months in both CAD and CAD + PAD groups. In total, 713 CAD patients were included in the study, 148 (20.8%) patients had also PAD, asymptomatic in nearly 15% of them (106). The 35.4% of patients had ABI value ≤ 0.9 and 46.0% > 1.3 ABI. A significantly higher incidence of major CV events and all-cause death was seen in patients with PAD than in those without. Over 80% of patients received the therapy for secondary CV prevention and difference was seen between groups. Our findings showed that the use of an easy automatic instrument to measure ABI, easily managed by nurses, allowed to detect PAD in a relevant proportion of CAD patients who otherwise would not have been recognized. This encourages performing PAD screening in primary care setting to optimize the management of major CV risk factors associated with PAD. NCTumber: NCT03921905.
外周动脉疾病（PAD）在冠状动脉疾病（CAD）患者中仍未得到充分诊断，在常规临床实践中，测量筛查PAD仍然存在障碍。我们在意大利初级保健机构中，使用一种简单的自动仪器测量踝臂压力指数（ABI），评估CAD患者中PAD的患病率。我们与32名全科医生（GPs）进行了一项多中心观察性研究。通过将ABI值异常、或有与PAD相关症状、或有下肢血运重建手术史的患者数量除以纳入研究的患者总数，计算PAD的患病率。还对CAD组和CAD+PAD组在12个月时的主要心血管临床事件发生率和全因死亡率进行了评估。该研究共纳入713例CAD患者，其中148例（20.8%）同时患有PAD，近15%（106例）无症状。35.4%的患者ABI值≤0.9，46.0%的患者ABI>1.3。与无PAD的患者相比，PAD患者的主要心血管事件和全因死亡发生率显著更高。超过80%的患者接受了二级心血管预防治疗，两组之间存在差异。我们的研究结果表明，使用一种由护士易于操作的简单自动仪器测量ABI，能够在相当比例的CAD患者中检测出PAD，否则这些患者可能不会被识别。这鼓励在初级保健机构中进行PAD筛查，以优化与PAD相关的主要心血管危险因素的管理。试验注册号：NCT03921905。
