Key result
In patients with peripheral artery disease and no cardiac symptoms, an ankle-brachial index below the median was associated with a significantly higher number of coronary artery segments with mixed plaques.
Why the study?
Does CTCA effectively detect CAD and correlate with peripheral atherosclerosis severity in patients with lower-extremity PAD and no cardiac symptoms?
Cross-Sectional (n=65)
No
Does CTCA effectively detect CAD and correlate with peripheral atherosclerosis severity in patients with lower-extremity PAD and no cardiac symptoms?
Absolute Event Rate: 2.3% vs 1.2%
p-value: p=0.02
CTCA effectively detects a high prevalence of asymptomatic coronary artery disease in patients with peripheral artery disease, with severity correlating with lower ABI and abnormal IMT.
INTRODUCTION: Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower‑extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated. OBJECTIVES: The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower‑extremity PAD and no cardiac symptoms. PATIENTS AND METHODS: Sixty‑five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower‑extremity PAD and no cardiac symptoms underwent CTCA. RESULTS: CTCA revealed CAD in 56 subjects. Twenty‑two had obstructive CAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty‑six individuals demonstrated abnormal carotid artery intima-media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049). CONCLUSIONS: CTCA may be effective to detect CAD in subjects with lower‑extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high‑risk coronary artery plaques.
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Miszalski−Jamka et al. (2013) conducted a cross-sectional in Lower-extremity peripheral artery disease without cardiac symptoms (n=65). Ankle-brachial index (ABI) lower than median vs. ABI equal to or higher than median was evaluated on Number of coronary artery segments with mixed plaques (p=0.02). In patients with peripheral artery disease and no cardiac symptoms, an ankle-brachial index below the median was associated with a significantly higher number of coronary artery segments with mixed plaques.
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