Impact of peripheral vascular disease on short- and long-term outcomes in patients undergoing non-emergent percutaneous coronary intervention in the drug-eluting stent era.
Academic Article
Overview
abstract
OBJECTIVES: This study sought to compare short- and long-term (4-year) outcomes in patients with and without peripheral vascular disease (PVD) following non-emergent percutaneous coronary intervention (PCI) in current clinical practice. BACKGROUND: Patients with PVD undergoing coronary revascularization have high rates of adverse short-term outcomes. However, the long-term clinical outcomes of patients with PVD undergoing PCI in the contemporary drug-eluting stent (DES) era have not been well characterized. METHODS: The 2004/2005 Cornell Angioplasty Registry database was used to evaluate the in-hospital and long-term clinical outcomes in patients undergoing non-emergent (urgent or elective) PCI. A total of 2455 study patients were examined. We excluded patients presenting with an ST-elevation myocardial infarction (MI) ≤ 24 hours, hemodynamic instability/shock, thrombolytic therapy ≤ 7 days, or renal insufficiency (creatinine ≥ 4 mg/dL). Mean clinical follow-up was 4.4 ± 1.1 years. RESULTS: Of the 2455 patients, a total of 173 (7%) had PVD and 2282 (93%) had no reported history of PVD. DESs were used in 87% of the PCIs. The incidence of in-hospital death (1.8% vs 0.1%; P=.006) was greater in the PVD group, whereas postprocedural MI (6.4% vs 6.8%; P=.810) and major adverse cardiovascular event rates including death, stroke, emergent coronary artery bypass graft/PCI, and MI (8.7% vs 7.0%; P=.360) were similar in the PVD versus no PVD groups. Long-term Kaplan-Meier survival (89.2% vs 76.2%; P<.001) was significantly higher in patients without PVD versus with PVD, respectively. After adjustment with a multivariate Cox regression analysis, long-term all-cause survival was similar in patients with versus without PVD (hazard ratio, 1.16; 95% confidence interval, 0.69-1.93; P=.581). CONCLUSIONS: In contemporary PCI utilizing DESs, glycoprotein IIb/IIIa inhibitors, and clopidogrel, PVD is associated with a higher in-hospital and 4-year all-cause mortality. In our study, this difference in long-term survival was mainly driven by a higher rate of comorbidities in the PVD population that underwent PCI.
