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Prognosis worse with proximal peripheral arterial disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with aortoiliac peripheral arterial disease (PAD) have worse event-free survival than patients with more distal PAD, according to a report in the Journal of the American College of Cardiology for March 2.

“This is the first study to report a poorer general prognosis of patients with proximal PAD compared with those with more distal PAD, independent of risk factors and comorbidities,” Dr. Victor Aboyans, from Dupuytren University Hospital, Limoges, France, and colleagues note.

Numerous reports have documented a poor cardiovascular disease prognosis in patients with PAD, the authors note, but it was unclear whether the region of PAD had an impact on prognosis.

To investigate, Dr. Aboyans’ team analyzed data from 400 patients with angiographically confirmed lower limb PAD (arterial stenosis of 50% or greater). The main outcome measure was the occurrence of the combined endpoint — death, nonfatal myocardial infarction or stroke, and coronary or carotid revascularization – during a mean follow-up period of 34 months.

Overall, 344 patients (86.0%) had infra-iliac disease and 211 (52.8%) had aortoiliac disease. Correlates of distal disease included older age, diabetes, hypertension, and renal failure; correlates of proximal disease included male gender and smoking.

Patients with aortoiliac disease had significantly worse event-free survival (p < 0.011). On final analysis, which accounted for several patient characteristics and established cardiovascular risk factors, subjects with proximal disease were more than three times as likely as those with distal disease to die or experience the combined endpoint during follow-up.

“Additional clinical and large-scale epidemiology studies are necessary to validate our findings,” the authors conclude.

They add, “If our findings were confirmed, this could result in additional risk stratification of PAD patients depending on which lower extremity arteries are affected.”

J Am Coll Cardiol 2010;55:898-903.