Symptomatic Peripheral Artery Disease and Worse 3-Year Outcomes Following PCI

Patients with a history of symptomatic peripheral arterial disease (PAD) were associated with increased risk for unfavorable clinical outcomes following percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). These findings were published in Atherosclerosis.

Data from the 4 TWENTE randomized trials conducted at 5 hospitals in the Netherlands, 2 in Belgium, and 1 in Israel were pooled for this study. Patients (N=9204) undergoing PCI were randomly assigned to receive differing DESs and were evaluated for 3-year outcomes on the basis of whether patients had a history of symptomatic PAD.

The PAD (n=695) and no PAD (n=8454) cohorts were mean aged 67.9±8.9 and 63.7±10.9 years (P <.001); 27.8% and 26.3% were women; 42.3% and 34.3% presented with stable angina pectoris (P <.001); 11.8% and 23.4% with ST-elevated myocardial infarction (MI; P <.001); and 21.7% and 17.9% with unstable angina pectoris (P =.041), respectively. The PAD cohort had higher rates of diabetes mellitus, renal failure, hypertension, hypercholesterolemia, previous stroke, left ventricular ejection fraction of less than 30%, previous MI, previous PCI, and previous coronary bypass surgery (all P <.001).

The PAD cohort had higher rates of target vessel failure (16.4% vs 9.4%), all-cause mortality (9.7% vs 4.5%; P <.001), cardiac death (4.7% vs 2.0%), MI (6.4% vs 4.1%), target vessel MI (5.5% vs 3.3%), target vessel revascularization (8.9% vs 5.8%), target lesion failure (13.5% vs 8.0%), and major adverse cardiac events (18.8% vs 10.9%), respectively.

At 3 years, PAD was associated with increased risk for target vessel failure (adjusted hazard ratio [aHR], 1.42; 95% CI, 1.12-1.73; P =.001), major adverse cardiac events (aHR, 1.36; 95% CI, 1.13-1.64; P =.001), all-cause mortality (aHR, 1.52; 95% CI, 1.17-1.99; P =.002), target lesion failure (aHR, 1.33; 95% CI, 1.07-1.67; P =.011), and target vessel revascularization (aHR, 1.37; 95% CI, 1.04-1.80; P =.026).

This study may have been limited by not examining patients for asymptomatic or undiagnosed PAD.

“…knowledge about a history of symptomatic PAD still allows to simply identify patients with an increased risk of unfavorable clinical outcome after coronary intervention, including a higher risk of repeated coronary revascularization, despite the use of contemporary stents,” the study authors wrote. “In clinical practice, knowledge about this higher event risk of PAD patients is useful, both during Heart Team discussions and when informing patients about their individual risk during and after the PCI procedure.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

ReferencePinxterhuis TH, Ploumen EH, Zocca P, et al. Outcome after percutaneous coronary intervention with contemporary stents in patients with concomitant peripheral arterial disease: A patient-level pooled analysis of four randomized trials. Atherosclerosis. Published online May 20, 2022. doi:10.1016/j.atherosclerosis.2022.05.002