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Peripheral arterial disease (PAD) is known to be associated with poor outcomes due to higher incidence of combined cardiovascular morbidity and mortality. We evaluated the clinical outcomes of patients (pts) who underwent peripheral transluminal angioplasty (PTA) for PAD with combined significant coronary artery disease (CAD) treated by percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT).
The outcomes of 311 consecutive pts with symptomatic PAD who underwent PTA were enrolled for the analysis. Pts were divided into two groups; 1) PAD with CAD underwent PCI (N=154) and 2) PAD with CAD treated with OMT (N=157). The incidence of restenosis, amputation rates and clinical outcomes were compared between the two groups up to 1 year.
PAD pts with CAD underwent PCI had suffered from more chronic kidney disease (CKD, 35.1% vs. 22.8%; p=0.024) and myocardial infarction (MI, 20.8% vs.1.9%; p<0.001). The incidence of claudication (20.1% vs. 6.4%; p<0.001) and gangrene (32.5% vs.15.9%; p=0.001) as the initial diagnosis for PAD were higher in pts with CAD underwent PCI. At 8 months follow-up, the incidence of binary restenosis, total occlusion of the limb were similar between the two groups. However, at 1-year follow up, the incidence of repeat PTA (8.7% vs. 18.0%; P=0.025) and below knee amputation rate (12.3% vs. 20.7%; p=0.060) were lower in pts with CAD underwent PCI. Major adverse cardiovascular events (MACE) were similar between the two groups.
PAD pts underwent PCI had higher comorbidity including CKD and MI, and more frequently presented with critical limb ischemia. However, the incidence of restenosis and amputation rate at 1 years were lower in CAD pts underwent PCI, suggesting there may be significant risk reduction by PTA and PCI compared with control group.