Author + information
- Windsor Tinga,b,
- Qi Zhaoa,b,
- Lloyd Haskella,b,
- Fedor Luriea,b,
- Jeffrey Bergera,b,
- Zubin Eapena,b,
- Matthew Valkoa,b,
- Veronica Alasa,b,
- Kelly Richa,b,
- Concetta Criveraa,b and
- Jeff Scheina,b
Background: Prevalence of coronary artery disease (CAD) among patients with severe peripheral artery disease (SPAD) has been well established, and both are known determinants of major adverse cardiovascular events (MACE). We sought to determine why MACE is elevated in SPAD patients with CAD.
Methods: A retrospective cohort study was conducted on over 7 million patients using Optum Humedica integrated data, 2007-15. Patients age ≥50 with SPAD diagnosis (defined as rest pain, ulceration or gangrene, atheroembolism of lower extremities, and thrombosis of abdominal aorta) were selected. The index date was the first date of SPAD diagnosis, and clinical activity was required 6 month pre and 12 month post index. We excluded patients with pre index intracranial hemorrhage, stroke, or transient ischemic attack. Patients that died in the post index period were included. SPAD patients were stratified into 2 cohorts; with and without pre index CAD diagnosis.
Prevalence of CAD in the pre and post index period was computed. Pre index demographic and clinical characteristics were summarized. Post index MACE (all-cause death, myocardial infarction [MI], lower limb amputation, ischemic stroke) was compared across cohorts. We then examined the association of CAD cohort status and post index MACE using a logistic regression, and adjusted for pre index characteristics selected by a stepwise statistical algorithm.
Results: This study included 13,016 SPAD patients (41.0% CAD). Average age was 70.2 years; females comprised 44.5%. Compared to the cohort without CAD, a greater proportion of the CAD cohort had pre index hypertension (87.4 vs 63.9%, p<0.001), and post index MI (17.4 vs 4.68%, p<0.001), death (17.4 vs 10.7%, p<0.001), and MACE (37.4 vs 22.4%, p<0.001). CAD cohort status had a 67% higher odds of MACE than without CAD status (OR=1.67, 95% CI=1.53-1.83). The pre and post index CAD prevalence were 41% and 56%, respectively, reflecting a likely underdiagnosis of CAD in 14% of patients.
Conclusions: SPAD patients with CAD have a higher proportion of MI and death, a greater odds of MACE, and an underdiagnosis of CAD. This underdiagnosis impacts timeliness of intervention and may contribute to higher incidence of MACE.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: PCI in Complex Patients
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1287-194
- 2017 American College of Cardiology Foundation