Severity of tibio peroneal arterial disease: A marker for coronary artery disease

Abstract

In patients with peripheral arterial disease, coronary artery disease (CAD) is more frequent in those with distal than with proximal occlusion. The severity of distal tibioperoneal lesions, however, has not been extensively evaluated as a predictor for severe CAD. This study was designed to investigate whether such an association exists. From January 1992 to December 1993, this case-control study compared the frequency and severity of CAD in two groups: the study group (34 patients) with severe tibioperoneal arterial disease without any of the crural arteries being completely patent; the control group (34 patients) with milder disease of the same segments with at least one crural artery completely patent. In both groups the lower limbs were angiographically evaluated. CAD was assessed by myocardial scintigraphy or coronary arteriography. The two groups were comparable regarding age and number of risk factors (p=NS). Severe CAD was more frequently found in the study group than in the controls (p < 0.001). The relative risk was seven times higher in the study group, with an odds ratio of 7.35 (confidence interval 2.03–28.2). CAD is much more frequent in patients with severe lower extremity arterial disease than in those with less advanced disease. The severity of distal disease appears to be a highly specific marker for identifying patients at higher risk.