Risk of death and myocardial infarction in patients with peripheral arterial disease undergoing percutaneous coronary intervention (from the National Heart, Lung and Blood Institute Dynamic Registry).
Patients with peripheral arterial disease (PAD) undergoing percutaneous coronary intervention (PCI) are at high risk for adverse cardiovascular events. Trends over time in outcomes with advances in PCI and medical therapy are unknown. We evaluated 866 patients with PAD in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry undergoing PCI according to treatment eras: the early bare metal stent (BMS) era (wave 1, 1997 to 1998, n = 180), the BMS era (waves 2 and 3, 1999 and 2001 to 2002, n = 339), and the drug-eluting stent (DES) era (waves 4 and 5, 2004 and 2006, n = 347). We compared in-hospital and 1-year outcomes by recruitment era. In-hospital coronary artery bypass graft surgery rates were significantly lower in the later eras (3.9%, 0.9%, and 0.6% for the early BMS, BMS, and DES eras, respectively, p for trend = 0.005), and an increasing percentage of patients were discharged on aspirin, β blockers, statins, and thienopyridines (p for trend <0.001 for all comparisons). Cumulative 1-year event rates in patients with PAD in the early BMS era, BMS era, and DES era for death were 13.7%, 10.5%, and 9.8% (p for trend = 0.21), those for myocardial infarction (MI) were 9.8%, 8.8%, and 10.0% (p for trend = 0.95), and those for repeat revascularization were 26.8%, 21.0%, and 17.2% (p for trend = 0.008). The 1-year adjusted hazard ratios of adverse events in patients with PAD using the early BMS era as the reference were 0.84 for death in the BMS era (95% confidence interval [CI] 0.46 to 1.55, p = 0.58) and 1.35 in the DES era (95% CI 0.71 to 2.56, p = 0.36), 0.89 for MI in the BMS era (95% CI 0.48 to 1.66, p = 0.72) and 1.02 in the DES era (95% CI 0.55 to 1.87, p = 0.95), and 0.63 for repeat revascularization in the BMS era (95% CI 0.41 to 0.97, p = 0.04) and 0.46 in the DES era (95% CI 0.29 to 0.73, p = 0.001). In conclusion, despite significant improvements in medical therapy and a decrease in repeat revascularization over time, patients with PAD who undergo PCI have a persistent high rate of death and MI.
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern, Dallas, Texas, USA.
Shailja V
SV
Parikh
Shoaib
S
Saya
Punag
P
Divanji
Subhash
S
Banerjee
Faith
F
Selzer
J Dawn
JD
Abbott
Srihari S
SS
Naidu
Robert L
RL
Wilensky
David P
DP
Faxon
Alice K
AK
Jacobs
Elizabeth M
EM
Holper
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality*; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000453:epidemiology*; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality*; D054555:National Heart, Lung, and Blood Institute (U.S.); D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data*; D019233:Retreatment; D012306:Risk; D015607:Stents; D014481:United States
Circ Cardiovasc Interv. 2009 Feb;2(1):20-6
20031689
J Endovasc Ther. 2004 Feb;11(1):60-70
14748627
J Cardiothorac Surg. 2007 Dec 03;2:51
18053186
Circulation. 2007 Sep 11;116(11 Suppl):I139-43
17846294
Am J Cardiol. 2003 Sep 1;92(5):582-3
12943879
Interact Cardiovasc Thorac Surg. 2009 Oct;9(4):654-8
19640868
Circ Cardiovasc Interv. 2009 Aug;2(4):317-22
20031734
Ann Thorac Surg. 2004 Aug;78(2):466-70; discussion 470
15276497
J Am Coll Cardiol. 2006 Oct 17;48(8):1567-72
17045889
Jpn Circ J. 2000 Dec;64(12):905-8
11194280
Am Heart J. 2006 Nov;152(5):835-41
17070142
J Am Coll Cardiol. 2000 Sep;36(3):674-8
10987583
Circulation. 2000 Dec 12;102(24):2945-51
11113044
Am J Cardiol. 2004 Jun 15;93(12):1536-9
15194030
Circulation. 2009 Aug 18;120(7):560-7
19652090
Ann Vasc Surg. 1997 Nov;11(6):612-9
9363307
Am J Cardiol. 2007 Nov 15;100(10):1538-42
17996515
Circulation. 1999 Jul 13;100(2):171-7
10402447
Am J Cardiol. 2003 Oct 15;92(8):964-6
14556873
Am J Cardiol. 1998 Feb 15;81(4):375-81
9485122
Am J Cardiol. 2003 Oct 15;92(8):972-4
14556876
Mayo Clin Proc. 2004 Sep;79(9):1113-8
15357032
J Am Coll Cardiol. 2005 Sep 6;46(5):815-20
16139130
Circulation. 2004 Sep 14;110(11 Suppl 1):II41-4
15364836
Am J Cardiol. 2005 Mar 1;95(5):575-80
15721094
J Am Coll Cardiol. 2001 Jun 1;37(7):1891-900
11401128
Arch Surg. 2006 Dec;141(12):1214-8; discussion 1219
17178964
J Vasc Surg. 1995 Mar;21(3):445-52
7877226