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CLINICAL RESEARCH: PERIPHERAL VASCULAR DISEASE

Long-Term Prognosis of Patients With Peripheral Arterial Disease

A Comparison in Patients With Coronary Artery Disease

Gijs M.J.M. Welten, MD^_*, Olaf Schouten, MD^_*, Sanne E. Hoeks, MSc, Michel Chonchol, MD, Radosav Vidakovic, MD^_*, Ron T. van Domburg, PhD, Jeroen J. Bax, MD^||, Marc R.H.M. van Sambeek, MD^_* and Don Poldermans, MD^,_*

^_* Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
^|| Department of Cardiology, Leiden University, Leiden, the Netherlands
Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, Colorado.

Manuscript received October 9, 2007; revised manuscript received November 20, 2007, accepted November 27, 2007.

^_* Reprint requests and correspondence: Prof. Dr. Don Poldermans, Department of Anesthesiology, Erasmus MC, Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands. (Email: d.poldermans{at}erasmusmc.nl).

Objectives: This study was designed to compare the long-term outcomes of patients with peripheral arterial disease (PAD) with a risk factor matched population of coronary artery disease (CAD) patients, but without PAD.

Background: The PAD is considered to be a risk factor for adverse late outcome.

Methods: A total of 2,730 PAD patients undergoing vascular surgery were categorized into groups: 1) carotid endarterectomy (n = 560); 2) elective abdominal aortic surgery (AAA) (n = 923); 3) acute AAA surgery (r-AAA) (n = 200), and 4) lower limb reconstruction procedures (n = 1,047). All patients were matched using the propensity score, with 2,730 CAD patients who underwent coronary angioplasty. Survival status of all patients was obtained. In addition, the cause of death and complications after surgery in PAD patients were noted. The Kaplan-Meier method was used to compare survival between the matched PAD and CAD population and the different operation groups. Prognostic risk factors and perioperative complications were identified with the Cox proportional hazards regression model.

Results: The PAD patients had a worse long-term prognosis (hazard ratio 2.40, 95% confidence interval 2.18 to 2.65) and received less medication (beta-blockers, statins, angiotensin-converting enzyme inhibitors, aspirin, nitrates, and calcium antagonists) than CAD patients did (p < 0.001). Cerebro-cardiovascular complications were the major cause of long-term death (46%). Importantly, no significant difference in long-term survival was observed between the AAA and lower limb reconstruction groups (log rank p = 0.70). After vascular surgery, perioperative cardiac complications were associated with long-term cardiac death, and noncardiac complications were associated with all-cause death.

Conclusions: Long-term prognosis of vascular surgery patients is significantly worse than for patients with CAD. The vascular surgery patients receive less cardiac medication than CAD patients do, and cerebro-cardiovascular events are the major cause of late death.

Abbreviations and Acronyms   AAA = elective infrarenal abdominal aortic surgery   ACE = angiotensin-converting enzyme   CAD = coronary artery disease   CCV = cerebro-cardiovascular   CEA = carotid endarterectomy   LLR = lower limb arterial reconstruction procedures   MI = myocardial infarction   PAD = peripheral arterial disease   r-AAA = acute infrarenal abdominal aortic surgery

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