Long-term prognosis of patients with peripheral arterial disease with or without polyvascular atherosclerotic disease.
OBJECTIVE
Patients with peripheral atherosclerotic disease often have multiple affected vascular beds (AVB), however, data on long-term follow-up and medical therapy are scarce. We assessed the prevalence and prognostic implications of polyvascular disease on long-term outcome in symptomatic peripheral arterial disease (PAD) patients.


RESULTS
Two thousand nine hundred and thirty-three consecutive patients were screened prior to surgery for concomitant documented cerebrovascular disease and coronary artery disease. The number of AVB was determined. Cardiovascular medication as recommended by guidelines was noted at discharge. Single, two, and three AVB were detected in 1369 (46%), 1249 (43%), and 315 (11%) patients, respectively. During a median follow-up of 6 years, 1398 (48%) patients died, of which 54% secondary to cardiovascular cause. After adjustment for baseline cardiac risk factors and discharge-medication, the presence of 2-AVB or 3-AVB was associated with all-cause mortality (HR 1.3 95% CI 1.2-1.5; HR 1.8 95% CI 1.5-2.2) and cardiovascular mortality (HR 1.5 95% CI 1.2-1.7; HR 2.0 95% CI 1.6-2.5) during long-term follow-up, respectively. Patients with 2- and 3-AVB received extended medical treatment compared with 1-AVB at the time of discharge.


CONCLUSIONS
Polyvascular atherosclerotic disease in PAD patients is independently associated with an increased risk for all-cause and cardiovascular mortality during long-term follow-up.
van Kuijk
Jan-Peter
JP
Department of Vascular Surgery, Erasmus Medical Center, 's Gravendijkwal 230, Room H-805, Rotterdam 3015 CE, The Netherlands.
Flu
Willem-Jan
WJ
Welten
Gijs M J M
GM
Hoeks
Sanne E
SE
Chonchol
Michel
M
Vidakovic
Radosav
R
Verhagen
Hence J M
HJ
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D058729:Peripheral Arterial Disease / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D011182:Postoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
D002317:Cardiovascular Agents