The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials.
OBJECTIVE
We aimed to evaluate clinical outcomes among peripheral arterial disease (PAD) patients following percutaneous coronary intervention (PCI).


BACKGROUND
A significant proportion of patients with coronary artery disease undergoing PCI have concomitant PAD, which may be associated with worse outcomes.


METHODS
We performed a pooled analysis of 8 randomized PCI trials. We included multicenter PCI trials that compared antiplatelet therapies (EPIC, EPILOG, EPISTENT, RAPPORT, CAPTURE, IMPACT-II, TARGET, and CREDO) and had baseline PAD status recorded. Multivariable analyses were performed with stepwise logistic regression for 7- and 30-day outcomes and Cox regression for 6-month and 1-year events.


RESULTS
In our pooled analysis of 19,867 patients undergoing PCI, 1,602 (8.1%) were previously diagnosed with PAD. Patients with PAD had higher incidences of 7-day death (1.0% vs. 0.4%; p < 0.001) or myocardial infarction (MI) (6.8% vs. 5.6%; p = 0.047), 30-day death (1.7% vs. 0.7%; p < 0.001) or MI (7.4% vs. 6.1%; p = 0.05), 6-month death (4.2% vs. 1.5%; p < 0.001) or MI (9.1%, vs. 7.7%; p = 0.048), and 1-year death (5.0% vs. 2.1%; p < 0.001). There was a trend toward higher major bleeding risk with PAD (4.8% vs. 3.9%; p = 0.06). With multivariable analyses, PAD remains a significant predictor of mortality at 30 days (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03 to 2.70; p = 0.039), 6 months (HR 1.76, 95% CI 1.31 to 2.37; p < 0.001), and 1 year (HR 1.46, 95% CI 1.08 to 1.96; p = 0.013).


CONCLUSIONS
The presence of PAD is associated with higher rates of post-PCI death and MI, and is an independent predictor of short- and long-term mortality.
Saw
Jacqueline
J
Department of Medicine, Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Bhatt
Deepak L
DL
Moliterno
David J
DJ
Brener
Sorin J
SJ
Steinhubl
Steven R
SR
Lincoff
A Michael
AM
Tcheng
James E
JE
Harrington
Robert A
RA
Simoons
Maarten
M
Hu
TingFei
T
Sheikh
Mobeen A
MA
Kereiakes
Dean J
DJ
Topol
Eric J
EJ
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001158:Arteries; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000150:complications*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic
D019039:Platelet Glycoprotein GPIIb-IIIa Complex