Polyvascular extracoronary atherosclerotic disease in patients with coronary artery disease.
BACKGROUND
Cardiovascular diseases are the number one killer in the developed countries, accounting for approximately half of all deaths, with the leading causes being myocardial infarction and ischaemic stroke. In line with the ageing population, the prevalence of coronary artery disease (CAD), lower extremity peripheral arterial disease (PAD), supra-aortic arterial disease (SAD) and renal stenosis (RAS) is increasing. Polyvascular atherosclerosis (PVA) coexisting in several territories has an adverse effect on cardiovascular morbidity and mortality.


OBJECTIVE
To determine prevalence, coexistence and predictors of significant PAD, SAD and RAS in patients with suspected CAD.


METHODS
Based on angiography, the frequency of coexisting CAD, SAD, PAD and RAS (stenosis > or =50%) was determined in 687 (487 male) consecutive patients, aged 63.5 +/- 9.1 years, referred for coronary angiography.


RESULTS
Significant CAD was found in 545 (79.3%) patients (1-vessel in 164; 2-vessel in 157; 3-vessel in 224). SAD, RAS and PAD were found in 136 (19.8%), 55 (8%), and 103 (15%) patients, respectively. Of the 545 patients with confirmed CAD, 346 (63.5%) had stenoses limited to coronary arteries. 2-, 3- and 4-level PVA was found in 130 (23.8%), 61 (11.2%) and 8 (1.5%) patients, respectively. Of the 142 patients without CAD, 127 (89.4%) had no significant stenoses elsewhere, 12 (8.5%) had 1 extracoronary territory and 3 (2.1%) had 2-territory involvement. Backward stepwise binary logistic regression analysis showed the following independent predictors of at least 2-level PVA: 2- and 3-vessel CAD (p < 0.001), hyperlipidaemia (p = 0.067), smoking (p < 0.001), creatinine level > or = 1.3 ml/dl (p < 0.001), lower extremities claudication (p < 0.001) and female gender (p = 0.003). The relative risk of having at least 2-territory PVA was 15.7-fold higher in patients with claudication, 2.1-fold in patients with multivessel CAD, 2.8-fold for serum creatinine level > 1.3 mg/dl; and 1.9-fold, 2.4-fold and 2-fold in patients with hyperlipidaemia, smokers and women, respectively.


CONCLUSIONS
Significant atherosclerosis in extracoronary arterial territories is present in 36% of patients with documented CAD. With advancing PVA, accumulation of atherosclerosis risk factors, previous atherothrombotic events and more severe CAD is observed.
Przewłocki
Tadeusz
T
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, The John Paul II Hospital, Krakow, Poland. tadeuszprzewlocki@op.pl
Kabłak-Ziembicka
Anna
A
Kozanecki
Artur
A
Rzeźnik
Daniel
D
Pieniazek
Piotr
P
Musiałek
Piotr
P
Piskorz
Adam
A
Sokołowski
Andrzej
A
Rosławiecka
Agnieszka
A
Tracz
Wiesława
W
D000328:Adult; D000368:Aged; D021921:Aortic Stenosis, Supravalvular / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology; D007383:Intermittent Claudication / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012078:Renal Artery Obstruction / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology