Prognosis of Patients With PAD Shown to Differ by Disease Localization

February 22, 2010—In the Journal of the American College of Cardiology, Victor Aboyans, MD, et al published finding from a single-center study that sought to assess the general prognosis of patients with peripheral arterial disease (PAD) according to the disease localization (2010;55:898–903). The background of the study is the understanding that PAD is associated with poor cardiovascular disease prognosis; however, it is unknown whether the general prognosis could differ according to PAD topography.

In the study, the investigators reviewed data for all patients who underwent an initial digital subtraction angiography of their lower limbs between January 2000 and December 2005 at the investigator’s hospital. Arterial stenoses ≥ 50% were located by two experienced vascular physicians. The events recorded until April 2007 were death, nonfatal myocardial infarction or stroke, and coronary or carotid revascularization. The primary outcome combined all these events.

The investigators studied 400 PAD patients (aged 68.3 ± 12.3 years; 77.5% men). They noted aortoiliac disease (proximal PAD) and infrailiac disease (distal PAD) in 211 (52.8%) and 344 (86%) cases, respectively. Male sex and smoking were more prevalent in proximal PAD, whereas older age, diabetes, hypertension, and renal failure were more prevalent in distal PAD (P < .05). During the follow-up period (34 ± 23 months), the event-free survival curves differed according to the PAD localization (P < .03). Adjusted for age, sex, cardiovascular disease history and cardiovascular disease risk factors, critical leg ischemia status, and treatments, proximal PAD was significantly associated with a worse prognosis (primary outcome hazard ratio, 3.28; death hazard ratio, 3.18; P < .002 versus distal PAD).

This study is the first to report a poorer general prognosis of patients with proximal (aortoiliac) PAD compared with those with more distal PAD, independent of risk factors and comorbidities, the investigators concluded.