Author + information
- Antonio Gutierrez1,
- Hillary Mulder2,
- Schuyler Jones2,
- Frank Rockhold2,
- Jeffrey Berger3,
- Juuso Blomster4,
- William Hiatt5,
- Brian Katona6,
- Lars Norgren7 and
- Manesh Patel2
- 1Duke University and Duke Clinical Research Institute, Durham, North Carolina, United States
- 2Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, United States
- 3Departments of Medicine and Surgery, New York University School of Medicine, New York, New York, United States
- 4AstraZeneca, Gothenburg, Molndal, Sweden
- 5University of Colorado School of Medicine, Aurora, Colorado, United States
- 6AstraZeneca, West Chester, Delaware, United States
- 7Faculty of Medicine and Health, Orebro University, Orebro, Sweden
The cardiovascular (CV) risk of polyvascular disease in the background of peripheral artery disease (PAD) has not been previously described.
EUCLID (NCT01732822) evaluated the effect of ticagrelor versus clopidogrel, in preventing CV events in 13,885 PAD patients. The primary efficacy (CV death, MI, and ischemic stroke) and primary safety (TIMI major bleeding) end points were compared between patients with PAD alone, PAD + cerebrovascular disease (CVD), PAD + coronary artery disease (CAD), and PAD + CVD + CAD. An adjusted Cox proportional hazards model was used to determine the risk over time of the primary end points.
At randomization, 7804 (56%) patients had PAD alone; 2639 (19%) had PAD + CAD; 2049 (15%) had PAD + CVD; and 1393 (10%) had PAD + CVD + CAD. The rates (events per 100 patient-years of follow-up) for the primary end point were as follows: PAD alone (3.4%), PAD + CVD (4.8%), PAD + CAD (5.7%), and PAD + CVD + CAD (8.1%). Compared with patients with isolated PAD, the adjusted hazard ratios for the primary endpoint in patients with PAD + CVD, PAD + CAD, and PAD + CVD + CAD were 1.34 (95% CI 1.15-1.57, p=0.0002), 1.65 (95% CI 1.43-1.91, p<0.0001), and 1.99 (95% CI 1.69-2.34, p<0.0001), respectively. Compared with isolated PAD, polyvascular disease was not associated with a significant increased risk of major bleeding.
In EUCLID, a trial of patients with PAD, 44% of patients had polyvascular disease. With a background of PAD, the risk of CV events increases with multiple vascular bed involvement, greatest in patients with concomitant CAD (PAD + CAD or PAD + CVD + CAD).
ENDOVASCULAR: Peripheral Vascular Disease and Intervention