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The impact of polyvascular disease on long‐term outcome in percutaneous coronary intervention patients
Author(s) -
Meer Ma G.,
Cramer Maarten J.,
Graaf Yolanda,
Appelman Yolande,
Doevendans Pieter A.,
Nathoe Hendrik M.
Publication year - 2014
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12222
Subject(s) - medicine , hazard ratio , cardiology , coronary artery disease , percutaneous coronary intervention , subclinical infection , stroke (engine) , myocardial infarction , clinical endpoint , vascular disease , disease , confidence interval , clinical trial , mechanical engineering , engineering
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 ( HR s) were adjusted for baseline characteristics. Results Mean follow‐up was 7·3 years. The HR s (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 HR s (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 HR s of patients with subclinical disease were comparable to the HR s 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.