title: Clinical outcomes of patients with critical limb ischemia who undergo routine coronary angiography and subsequent percutaneous coronary intervention.
abstract: BACKGROUND
  Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA).
  
  
  METHODS
  Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis.
  
  
  RESULTS
  Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P=.45), myocardial infarction (1.1% vs 0%; P=.31), and PCI (4.7% vs 1.1%; P=.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P=.86), target lesion revascularization (13.7% vs 14.1%; P=.94), and amputation (19.1% vs 16.4%; P=.60).
  
  
  CONCLUSIONS
  A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, 80, Gurodong, Guro-gu, Seoul, 152-703, Korea. swrha617@yahoo.co.kr.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Seung Kyu
authors.initials: SK
authors.lastname: Han
authors.forename: Byoung Geol
authors.initials: BG
authors.lastname: Choi
authors.forename: Se Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Yoonjee
authors.initials: Y
authors.lastname: Park
authors.forename: Raghu
authors.initials: R
authors.lastname: Akkala
authors.forename: Hu
authors.initials: H
authors.lastname: Li
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Im
authors.forename: Ji Bak
authors.initials: JB
authors.lastname: Kim
authors.forename: Sunki
authors.initials: S
authors.lastname: Lee
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Na
authors.forename: Cheol Ung
authors.initials: CU
authors.lastname: Choi
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Eung Ju
authors.initials: EJ
authors.lastname: Kim
authors.forename: Chang Gyu
authors.initials: CG
authors.lastname: Park
authors.forename: Hong Seog
authors.initials: HS
authors.lastname: Seo
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000150:complications / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016638:Critical Illness; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome