Abstract
Background and aimsPatients with peripheral artery disease (PAD) represent a high risk group, and have an increased risk of cardiovascular events and worse cardiovascular outcomes. Our aim was to study the impact of PAD among patients undergoing percutaneous coronary intervention (PCI) with a newer-generation thin-strut DES. MethodsIn this analysis of the e‐ULTIMASTER registry, patients with and without known PAD undergoing PCI were compared. A propensity-score was used to adjust for differences between the groups. The primary outcome was target lesion failure (TLF): a composite of cardiac death, target‐vessel related myocardial infarction, and/or clinically driven target lesion revascularization at 1‐year follow‐up. ResultsOf 33,880 patients included in the analysis, PAD was present in 2255 (6.7%). Patients with PAD were older (69.0 ± 10.0 vs. 63.8 ± 11.3 years) with a higher burden of comorbidities. Patients with PAD were less likely to present with STEMI (9.6% vs. 21%), and more likely to undergo complex PCI (left main 5.5% vs. 3.0% ostial lesions 10.4% vs. 7.0%, bifurcations 14.5% vs. 12.3% and calcification 26.8% vs. 17.8%). PAD was found to be independently associated with 41% increased risk for TLF. The risk for all cause death and for cardiac death was 75% and 103% higher, respectably. No difference was found in the rates of stent thrombosis, clinically driven target lesion revascularization, or myocardial infarction (MI). ConclusionsPatients with PAD are at higher risk for (cardiac) death post PCI, but not target vessel or lesion repeat revascularizations. The PAD cohort represents a population with a higher risk clinical profile. Further research combining medical and device therapies is needed to further improve the outcomes in this high-risk population.
Highlights
Peripheral artery disease (PAD) is a common condition, with an increasing prevalence over recent decades, estimated to occur in over 200 million people worldwide [1,2] with symptoms ranging from mild to severe
After adjustment for differences in clinical and angiographic characteristics, patients with peripheral artery disease (PAD) treated with contem porary thin strut drug eluting stents (DES) did not have significant higher risk of stent thrombosis, target vessel myocardial infarction (MI), or TV/TL revascularization compared to patients without PAD
Never theless, it should be noted that in our study patients with PAD treated with contemporary thin struts DES did not experience higher adjusted rates of stent thrombosis, CD TL/TV revascularization, or MI
Summary
Peripheral artery disease (PAD) is a common condition, with an increasing prevalence over recent decades, estimated to occur in over 200 million people worldwide [1,2] with symptoms ranging from mild to severe. The presence of PAD indicates an increased risk for CAD, but is associated with worse clinical outcomes in patients with myocardial infarction (MI) [4, 5] and percutaneous coronary intervention (PCI) [6]. Most of the data that has reported on post-PCI outcomes in patients with PAD is derived from studies performed using bare metal stents (BMS) or early-generation drug eluting stents (DES). Patients with peripheral artery disease (PAD) represent a high risk group, and have an increased risk of cardiovascular events and worse cardiovascular outcomes. Conclusions: Patients with PAD are at higher risk for (cardiac) death post PCI, but not target vessel or lesion repeat revascularizations. Further research combining medical and device therapies is needed to further improve the outcomes in this high-risk population
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