title: Percutaneous peripheral interventions in patients with non-ST elevation acute coronary syndromes performed by interventional cardiologists: rationale and results.
abstract: BACKGROUND
  The coexistence of peripheral artery disease (PAD) and multilevel atherosclerosis increases death and stroke rates in patients with coronary artery disease (CAD). Due to many comorbidities these patients are often treated conservatively without revascularisation.
  
  
  OBJECTIVE
  To investigate whether complex percutaneous cardiovascular interventions for CAD and PAD may improve prognosis and long-term outcome in this group of patients.
  
  
  METHODS
  We studied consecutive patients treated for symptomatic CAD who also had chronic PAD. The primary cause of hospital admission for all our patients was non-ST elevation acute coronary syndrome (NSTE ACS). All percutaneous peripheral interventions were performed during one hospital stay (index hospitalisation). Major adverse cardio- and cerebrovascular events (MACCE) during follow-up were defined as follows: death (cardiac and non-cardiac), myocardial infarction (MI), urgent revascularisation (surgical or repeat PCI, peripheral percutaneous intervention), stroke/TIA or amputation.
  
  
  RESULTS
  We performed 109 interventions in 78 consecutive patients with chronic peripheral artery stenoses and occlusions. The average age was 61.5+/-8.6 years and the majority were males (80%). Preinterventional angiography showed occlusions that involved the common iliac artery in 28 (36%) patients, the external iliac artery in 16 (21%) patients, internal iliac artery in 2 (3%) patients, and superficial femoral artery in 63 (81%) patients. Stenting was performed in half of the patients with a mean stent length of 69.6+/-50.3 mm. An average number of 1.24+/-0.55 stents was used for each lesion. During a mean follow-up of 18 months (range 4 to 42), there were 4 deaths, 3 MIs, 13 repeated percutaneous peripheral interventions due to restenosis in previously treated peripheral lesions, two urgent coronary interventions, two ischaemic strokes, two TIAs and one amputation. The combined follow--up MACCE end-point occurred in 32% of patients.
  
  
  CONCLUSIONS
  Patients with concomitant CAD and PAD could safely undergo percutaneous cardiovascular and peripheral interventions. Multilevel intervention is associated with a promising long-term follow-up.
authors.affiliation: Institute of Cradiology, Collegium Medicum, Jagiellonian University, Krakow, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Bartuś
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Siudak
authors.forename: Michał
authors.initials: M
authors.lastname: Brzeziński
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Michał
authors.initials: M
authors.lastname: Chyrchel
authors.forename: Jacek
authors.initials: J
authors.lastname: Jakała
authors.forename: Jacek
authors.initials: J
authors.lastname: Dubiel
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D013997:Time Factors; D016896:Treatment Outcome