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LAS VEGAS -- Patients with peripheral arterial disease (PAD) who receive coronary stents are at an increased risk of death out past 4 years, researchers found.
In a cohort of roughly 2,500 stent patients, long-term survival for PAD patients was 76% versus 89% for patients with no evidence of PAD (P<0.001), Konstantinos Charitakis, MD, from New York Presbyterian Hospital in New York City, and colleagues reported at the annual meeting of the Society for Cardiovascular Angiography and Interventions.
Action Points
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- Note that in this study, PCI utilizing DES, glycoprotein IIb/IIIa inhibitors, and clopidogrel in patients with peripheral vascular disease was associated with a higher inhospital and 4-year all-cause mortality, thought to be largely due to a higher rate of comorbidities.
It is well-recognized that patients with widespread arterial disease have a higher risk of inhospital death following coronary artery stenting -- 1.7% versus 0.1% (P=0.006) in this analysis, but Charitakis said this is the first paper to report long-term risk.
When the researchers adjusted for comorbidities, the mortality risk was statistically similar, Charitakis told 番茄社区.
"This means that the stenting procedure itself is not putting these patients at risk," he said. "It is their other conditions, such as heart failure, prior stroke, renal insufficiency, and age that puts them at increased risk."
He suggested that internists and cardiologists need to better screen patients for PAD before they show up at age 70 needing a coronary stent.
"It's very easy to conduct a clinical exam, to listen to the carotids or feel the pulse of the peripheral arteries," Charitakis said.
"Atherosclerosis is a systemic disease, and only a systemic treatment with an emphasis on lipids, blood pressure, glucose control, and other risk factors will ensure that people are given the best aggressive treatment to maintain health," he said.
Charitakis and colleagues analyzed data from the 2004 to 2005 Cornell Angioplasty Registry database and identified 2,455 patients for this analysis, 173 of whom had PAD in addition to heart disease. Nearly 90% of the patients received drug-eluting stents.
Even though those with PAD had higher rates of death compared with those without PAD, rates of heart attack, stroke, and other major complications were not significantly different between the two groups.
The only very significant PAD patient characteristics that put them at risk of death were age (median 70), current heart failure, creatinine clearance, and previous stroke (all P<0.001). Diabetes and congestive heart failure were moderately significant.
"Those with peripheral vascular disease tend to have worse outcomes over the long term, and it may be because they have many other health problems that increase the severity of atherosclerosis and make it more likely they'll have a heart attack or stroke in the future," Charitakis said. "If we focus on treating those health problems, we may be able to improve long-term outcomes in this high-risk group of patients."
Disclosures
Charitakis as well as all the authors associated with this study reported they had no potential conflicts of interest.
Primary Source
Society for Cardiovascular Angiography and Interventions
Source Reference: Charitakis K, et al "Long-term survival of patients with and without peripheral vascular disease following percutaneous coronary interventions in the drug-eluting stent era" SCAI 2012; Poster A-037.