Impact of peripheral vascular disease on short- and long-term outcomes in patients undergoing non-emergent percutaneous coronary intervention in the drug-eluting stent era

J Invasive Cardiol. 2013 Mar;25(3):132-6.


Objectives: This study sought to compare short- and long-term (4-year) outcomes in patients with and without peripheral vascular disease (PVD) following non-emergent percutaneous coronary intervention (PCI) in current clinical practice.

Background: Patients with PVD undergoing coronary revascularization have high rates of adverse short-term outcomes. However, the long-term clinical outcomes of patients with PVD undergoing PCI in the contemporary drug-eluting stent (DES) era have not been well characterized.

Methods: The 2004/2005 Cornell Angioplasty Registry database was used to evaluate the in-hospital and long-term clinical outcomes in patients undergoing non-emergent (urgent or elective) PCI. A total of 2455 study patients were examined. We excluded patients presenting with an ST-elevation myocardial infarction (MI) ≤ 24 hours, hemodynamic instability/shock, thrombolytic therapy ≤ 7 days, or renal insufficiency (creatinine ≥ 4 mg/dL). Mean clinical follow-up was 4.4 ± 1.1 years.

Results: Of the 2455 patients, a total of 173 (7%) had PVD and 2282 (93%) had no reported history of PVD. DESs were used in 87% of the PCIs. The incidence of in-hospital death (1.8% vs 0.1%; P=.006) was greater in the PVD group, whereas postprocedural MI (6.4% vs 6.8%; P=.810) and major adverse cardiovascular event rates including death, stroke, emergent coronary artery bypass graft/PCI, and MI (8.7% vs 7.0%; P=.360) were similar in the PVD versus no PVD groups. Long-term Kaplan-Meier survival (89.2% vs 76.2%; P<.001) was significantly higher in patients without PVD versus with PVD, respectively. After adjustment with a multivariate Cox regression analysis, long-term all-cause survival was similar in patients with versus without PVD (hazard ratio, 1.16; 95% confidence interval, 0.69-1.93; P=.581).

Conclusions: In contemporary PCI utilizing DESs, glycoprotein IIb/IIIa inhibitors, and clopidogrel, PVD is associated with a higher in-hospital and 4-year all-cause mortality. In our study, this difference in long-term survival was mainly driven by a higher rate of comorbidities in the PVD population that underwent PCI.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Drug-Eluting Stents*
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / instrumentation*
  • Percutaneous Coronary Intervention / methods*
  • Peripheral Vascular Diseases / mortality*
  • Peripheral Vascular Diseases / therapy*
  • Registries
  • Retrospective Studies
  • Stroke / epidemiology
  • Survival Rate
  • Time Factors
  • Treatment Outcome