title: Comparison of mortality in patients with coronary or peripheral artery disease following the first vascular intervention.
abstract: OBJECTIVE
  Patients with peripheral artery disease (PAD) less frequently achieve secondary prevention goals compared with patients with coronary artery disease (CAD). We aimed to compare mortality rates in patients with PAD and CAD following first vascular intervention.
  
  
  METHODS
  Patients 18 years of age or older without a history of cardiovascular disease, who underwent first coronary or lower limb vascular intervention between 2002 and 2010, were included in this study. The primary endpoint was all-cause mortality.
  
  
  RESULTS
  Of the 9950 participants, 8242 (82.8%) underwent first coronary revascularization and 1708 (17.2%) received first peripheral vascular intervention. During a mean follow-up period of 5.6±2.3 years, 1283 (12.9%) participants died. Compared with CAD patients, patients with PAD had significantly worse long-term prognosis with an increased risk for all-cause mortality (hazard ratio=2.95, 95% confidence interval 2.6-3.3, P<0.0001). This association remained statistically significant following a multivariable analysis (hazard ratio=1.86, 95% confidence interval 1.6-2.1, P<0.0001). Furthermore, PAD patients were less frequently treated with cardioprotective medications including statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, aspirin, and clopidogrel (P<0.001).
  
  
  CONCLUSIONS
  Patients with PAD have worse outcome compared with patients with CAD, even in the specific group of patients following first vascular intervention. These findings demand more effort to improve secondary prevention guidelines in all patients with cardiovascular diseases, but especially in PAD patients.
authors.affiliation: aDivision of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada bDivision of Cardiology cDepartment of Internal Medicine A, Meir Medical Center, Kfar-Saba dSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv eDepartment of Family Medicine fSharon-Shomron District, Clalit Health Services, Netanya, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Pereg
authors.forename: Avishay
authors.initials: A
authors.lastname: Elis
authors.forename: Yoram
authors.initials: Y
authors.lastname: Neuman
authors.forename: Morris
authors.initials: M
authors.lastname: Mosseri
authors.forename: David
authors.initials: D
authors.lastname: Segev
authors.forename: Martine
authors.initials: M
authors.lastname: Granek-Catarivas
authors.forename: Michael
authors.initials: M
authors.lastname: Lishner
authors.forename: Doron
authors.initials: D
authors.lastname: Hermoni
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000401:mortality*; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*
chemical_list: D002317:Cardiovascular Agents