title: Prevalence of coronary heart disease in patients with aortic aneurysm and/or peripheral artery disease.
abstract: Although the presence of coronary heart disease (CHD) was the major determinant of perioperative mortality and long-term prognosis in patients with aortic aneurysm (AA) and peripheral artery disease (PAD), the prevalence and severity of CHD in patients with individual vascular diseases was unknown. Adenosine triphosphate-loading myocardial single-photon emission computed tomography therefore was performed in 788 patients with vascular diseases of the aorta and peripheral arteries, with AA in 500, PAD localized in the lower-limb arteries in 183, and combined AA and PAD in 105. Patients with known CHD, such as those with previous myocardial infarction or revascularization procedures, were excluded. Myocardial single-photon emission computed tomography was analyzed using a 20-segment model, and summed stress scores and summed difference scores were calculated. Stress-induced myocardial ischemia was defined as a summed difference score >or=2. The presence of myocardial ischemia was highest in patients with combined PAD and AA (73%), followed by PAD (55%; p = 0.005), and the lowest in patients with AA (37%; p <0.0001). Summed stress score was also the highest in patients with combined PAD and AA (11.6 +/- 9.9), followed by PAD (7.8 +/- 8.8; p <0.0001), and the lowest in patients with AA (4.0 +/- 6.2; p <0.0001 for both). Similarly, summed difference score was the highest in patients with combined PAD and AA (6.4 +/- 6.1), followed by PAD (4.4 +/- 5.7; p = 0.001) and AA (2.3 +/- 4.0; p <0.0001 for both). In conclusion, the prevalence of CHD in patients with PAD was >50%, and although myocardial ischemia was observed in only (1/3) of patients with AA, its prevalence not only doubled, but also indicated extensive myocardial ischemia when combined with PAD. Thus, cardiac evaluation was particularly important in patients with combined AA and PAD.
authors.affiliation: Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hirose
authors.forename: Taishiro
authors.initials: T
authors.lastname: Chikamori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hida
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Nobusato
authors.initials: N
authors.lastname: Koizumi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawaguchi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Obitsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigematsu
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011336:Probability; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*