Occult aorto-iliac disease in patients with symptomatic coronary artery disease.
BACKGROUND
Atherosclerosis may affect the entire cardiovascular system despite absence of symptoms. Early changes in the wall of the carotid artery have been related to a higher morbidity and mortality from coronary artery disease (CAD). This study was conducted to investigate the relationship between the presence of occult aorto-iliac disease (OAID) and certain risk factors with the severity of CAD.


METHODS
Two hundred and eighty-four consecutive patients subjected to coronary angiography (CA) were studied. Additional images of the aorto-iliac arterial segment were taken. Patients with negative CA or symptomatic lower limb arterial disease (LLAD) were excluded from further analysis. In the remaining patients, the risk factors (age, smoking, diabetes mellitus, hypertension, hyperlipidemia and positive family history for atherosclerosis) and the severity of coronary artery disease (CAD) were analyzed in relation to the presence or absence of OAID.


RESULTS
Twelve patients with impaired renal function were excluded from the study. Negative CA was found in 12% (32/272) and symptomatic LLAD was present in 14% (37/272). Eligible for further analysis were 203 patients with positive CA and no LLAD. A hundred and ten of them had a positive CA and the presence of OAID whereas the remaining 93 patients had only a positive CA. The patients with OAID had more severe CAD on CA (p=0.003). There was no difference between the two groups concerning age and gender. The most common risk factors in both groups were hypercholesterolemia and a positive family history but with a significantly higher prevalence in the patients with OAID (p=0.008 and p<0.001, respectively).


CONCLUSIONS
The presence of OAID in coronary patients was associated with more severe CAD and with a significantly higher prevalence of hypercholesterolemia and positive family history for atherosclerosis. This subset of patients may represent those with more aggressive atherosclerosis.
Kafetzakis
A
A
Division of Vascular Surgery, University Hospital of Heraklion, University of Crete School of Medicine, Heraklion, Crete, Greece.
Giannoukas
A D
AD
Kochiadakis
G
G
Igoumenidis
N
N
Vlachonikolis
I G
IG
Tsetis
D
D
Katsamouris
A
A
D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000150:complications*; D001161:Arteriosclerosis / Q000150:complications*; D003327:Coronary Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index