The impact of polyvascular disease on long-term outcome in percutaneous coronary intervention patients

BACKGROUND: Previous studies demonstrated the prognostic importance of concomitant polyvascular disease in patients with coronary artery disease (CAD). However, the significance of the number of diseased vascular territories and subclinical disease is unknown.

MATERIALS AND METHODS: The number of diseased vascular territories was evaluated in 2299 percutaneous coronary intervention (PCI) patients. Vascular disease was defined by documented atherosclerotic disease, either diagnosed in the medical history (clinical) or at the standardized cardiovascular screening (subclinical). The following territories were evaluated: cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm and vascular renal disease. The outcome measures were all-cause mortality, cardiovascular mortality and a composite cardiovascular endpoint (myocardial infarction, stroke, cardiovascular mortality). Patients with monovascular disease (CAD) served as the reference category. Hazard ratios (HRs) were adjusted for baseline characteristics.

RESULTS: Mean follow-up was 7.3 years. The HRs (95% confidence interval) for patients with two diseased territories compared to monovascular disease were for all-cause mortality 1.60 (1.14-2.25), cardiovascular mortality 2.13 (1.29-3.50) and the combined cardiovascular endpoint 1.66 (1.20-2.31). Moreover, the HRs (95% confidence intervals) for patients with more than two diseased territories compared to monovascular disease were for all-cause mortality 3.81 (2.45-5.92), cardiovascular mortality 4.40 (2.32-8.35) and the combined cardiovascular endpoint 2.75 (1.69-4.47). The HRs of patients with subclinical disease were comparable to the HRs of patients with clinical disease.

CONCLUSIONS: In patients undergoing PCI, the presence of subclinical and clinical polyvascular disease is associated with an increased long-term mortality and morbidity. Moreover, the outcome is highly influenced by the number of diseased territories.