Key result
Following first vascular intervention, PAD is linked to ~86% higher all-cause mortality than CAD.
Why the study?
Patients with peripheral artery disease less frequently achieve secondary prevention goals compared with patients with coronary artery disease, and mortality rates following first vascular intervention have not been compared.
Does first peripheral vascular intervention compared with first coronary revascularization associate with higher all-cause mortality in patients without prior cardiovascular disease?
Cohort (n=9,950)
Does first peripheral vascular intervention compared with first coronary revascularization associate with higher all-cause mortality in patients without prior cardiovascular disease?
Answers are grounded in this paper and cite their sources.
Patients with PAD have a significantly higher long-term mortality risk following their first vascular intervention compared to CAD patients, highlighting a need for improved secondary prevention in this population.
OBJECTIVES: Patients with peripheral artery disease (PAD) less frequently achieve secondary prevention goals compared with patients with coronary artery disease (CAD). We aimed to compare mortality rates in patients with PAD and CAD following first vascular intervention. PATIENTS AND METHODS: Patients 18 years of age or older without a history of cardiovascular disease, who underwent first coronary or lower limb vascular intervention between 2002 and 2010, were included in this study. The primary endpoint was all-cause mortality. RESULTS: Of the 9950 participants, 8242 (82.8%) underwent first coronary revascularization and 1708 (17.2%) received first peripheral vascular intervention. During a mean follow-up period of 5.6±2.3 years, 1283 (12.9%) participants died. Compared with CAD patients, patients with PAD had significantly worse long-term prognosis with an increased risk for all-cause mortality (hazard ratio=2.95, 95% confidence interval 2.6-3.3, P<0.0001). This association remained statistically significant following a multivariable analysis (hazard ratio=1.86, 95% confidence interval 1.6-2.1, P<0.0001). Furthermore, PAD patients were less frequently treated with cardioprotective medications including statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, aspirin, and clopidogrel (P<0.001). CONCLUSION: Patients with PAD have worse outcome compared with patients with CAD, even in the specific group of patients following first vascular intervention. These findings demand more effort to improve secondary prevention guidelines in all patients with cardiovascular diseases, but especially in PAD patients.
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Pereg et al. (2013) conducted a cohort in Peripheral artery disease vs Coronary artery disease (n=9,950). Peripheral artery disease (first peripheral vascular intervention) vs. Coronary artery disease (first coronary revascularization) was evaluated on All-cause mortality (HR 1.86, 95% CI 1.6-2.1, p=<0.0001). Following first vascular intervention, peripheral artery disease was associated with higher all-cause mortality than coronary artery disease.
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