Abstract
Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.
Highlights
Peripheral arterial disease (PAD) belongs to atherosclerotic diseases and is predictive for future cardiovascular events
In their consensus report in the year 2000, the TransAtlantic Inter-Society Consensus (TASC) Group described the five year fate of a patient with intermittent claudication: 5–10% of these patients were expected to suffer from non-fatal cardiovascular events, 30% were supposed to die mostly due to vascular reasons and only 55–60% of patients were expected to be alive without new cardiovascular complications after 5 years of observation[5]
Prevalent cardiovascular disease (CVD) was defined as documented cardiovascular events or procedures, such as myocardial infarction, percutaneous transluminal coronary angioplasty, aortocoronary bypass surgery, and/or coronary angiography with proven coronary stenosis ≥5 0 or stroke/Transient ischemic attack (TIA)
Summary
Peripheral arterial disease (PAD) belongs to atherosclerotic diseases and is predictive for future cardiovascular events. In the early 1960s Begg and Richards as well as Juergens already recognized that PAD patients in the state of intermittent claudication (IC) with clinical or electrocardiographic signs of coronary ischemia had a survival probability comparable to patients who had survived a myocardial infarction[3,4] In their consensus report in the year 2000, the TransAtlantic Inter-Society Consensus (TASC) Group described the five year fate of a patient with intermittent claudication: 5–10% of these patients were expected to suffer from non-fatal cardiovascular events, 30% were supposed to die mostly due to vascular reasons and only 55–60% of patients were expected to be alive without new cardiovascular complications after 5 years of observation[5]. The remaining years of follow-up were considered for incidence rate analysis
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