Long-term cardiovascular outcomes following ischemic heart disease in patients with and without peripheral vascular disease.

BACKGROUND: Peripheral vascular disease (PVD) is associated with an increased risk of cardiovascular disease. However, few studies have evaluated the prognosis of asymptomatic PVD in patients with coronary artery disease (CAD).

METHODS: The aim of the study was to determine the prevalence of asymptomatic and symptomatic PVD in patients with ST-elevated myocardial infarction (STEMI) or unstable angina pectoris (UAP) who underwent percutaneous coronary intervention (PCI), and to conduct a 3-year follow-up for cardiovascular events. Systemic atherosclerosis was evaluated, using duplex ultrasonography in 380 consecutive patients who had undergone PCI from January 2003 to December 2005.

RESULTS: Twenty-four percent of the CAD patients had PVD. Patients with PVD had significantly more risk factors for atherosclerosis, including increased age, diabetes mellitus, smoking (p < 0.05), and multivessel CAD (p < 0.001). Multivariate regression analysis demonstrated that STEMI, PVD and multivessel CAD were independent predictors for major adverse cardiac events (MACE) (p < 0.05). Kaplan-Meier curves for MACE in all the patients showed that the MACE rates were significantly higher in STEMI and PVD cases compared with other cases (p < 0.05). We also classified patients with PVD into symptomatic (53%) and asymptomatic (47%) cases, and the MACE rates between these groups did not differ significantly (p < 0.82).

CONCLUSIONS: There is a high prevalence of asymptomatic PVD in patients with CAD and even asymptomatic PVD is associated with increased CAD mortality.