Long-Term Prognostic Risk in Lower Extremity Peripheral Arterial Disease as a Function of the Number of Peripheral Arterial Lesions.
BACKGROUND
Although patients with peripheral artery disease (PAD) are known to have an increased risk of adverse prognosis, simple techniques to further risk-stratify PAD patients would be clinically useful. A plausible but unexplored factor to predict such risk would be greater disease burden, manifested as multiple lower extremity lesions. The aim of this study was to examine the association between having multiple versus isolated lower extremity PAD lesions and long-term prognosis.


RESULTS
A prospective cohort of 756 newly diagnosed PAD patients underwent duplex ultrasound testing to determine the number of lower extremity lesions. Cox regression models examined the independent association of lesion number (≥3 and 2 versus 1) and adverse prognosis (defined as a composite end point comprising first occurrence of either lower extremity amputation, admission for heart failure, nonfatal stroke, myocardial infarction, or unstable angina or mortality), adjusting for demographic and clinical risk factors. Analyses were replicated using an advanced Cox-based model for multiple events. A total of 173 patients (23%) had ≥3 lesions, 197 (26%) had 2 lesions, and 386 (51%) had 1 lesion. After a median follow-up of 3.2 years, patients with ≥3 lesions had an increased risk of experiencing a first adverse event (adjusted hazard ratio 1.60, 95% CI 1.08-2.38, P=0.020) and an increased risk of having multiple events (adjusted hazard ratio 1.53, 95% CI 1.08-2.18, P=0.018). Patients with 2 lesions had a prognosis similar to those with 1 lesion.


CONCLUSIONS
Among PAD patients, a greater number of lesions is associated with an increased risk of an adverse prognosis over 3 years of follow-up. Assessing the number of lower extremity lesions might serve as a simple risk-stratification tool at initial PAD diagnosis.
Department of Public Health, Faculty of Medicine & Health Sciences, Ghent Univeristy, Ghent, Belgium (K.G.S.) University of Missouri-Kansas City (UMKC), Kansas City, MO (K.G.S., J.A.S.) Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S.).
Kim G
KG
Smolderen
St. Elisabeth Hospital, Department of Vascular Surgery, Tilburg, The Netherlands (M.Z., P.G.J., J.M.H., M.J.N., P.W.V.).
Moniek
M
van Zitteren
St. Elisabeth Hospital, Department of Vascular Surgery, Tilburg, The Netherlands (M.Z., P.G.J., J.M.H., M.J.N., P.W.V.).
Philip G
PG
Jones
University of Missouri-Kansas City (UMKC), Kansas City, MO (K.G.S., J.A.S.) Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S.).
John A
JA
Spertus
St. Elisabeth Hospital, Department of Vascular Surgery, Tilburg, The Netherlands (M.Z., P.G.J., J.M.H., M.J.N., P.W.V.).
Jan M
JM
Heyligers
St. Elisabeth Hospital, Department of Vascular Surgery, Tilburg, The Netherlands (M.Z., P.G.J., J.M.H., M.J.N., P.W.V.).
Maria J
MJ
Nooren
St. Elisabeth Hospital, Department of Vascular Surgery, Tilburg, The Netherlands (M.Z., P.G.J., J.M.H., M.J.N., P.W.V.).
Patrick W
PW
Vriens
Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (J.D.).
Johan
J
Denollet
D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D058729:Peripheral Arterial Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex
claudication; peripheral artery disease; prognosis; statistics; survival