Skip to main content
Top
Published in: Heart and Vessels 8/2023

Open Access 13-04-2023 | Myocardial Infarction | Original Article

Association between complete revascularization of the coronary artery and clinical outcomes in peripheral artery disease: a sub-analysis of the I-PAD Nagano registry

Authors: Tamon Kato, Yasushi Ueki, Masatoshi Minamisawa, Takashi Miura, Yushi Oyama, Naoto Hashizume, Daisuke Yokota, Minami Taki, Keisuke Senda, Yoshiteru Okina, Tadamasa Wakabayashi, Koki Fujimori, Kenichi Karube, Takahiro Sakai, Hidetomo Nomi, Hisanori Yui, Yusuke Kanzaki, Keisuke Machida, Shusaku Maruyama, Ayumu Nagae, Tatsuya Saigusa, Soichiro Ebisawa, Ayako Okada, Hirohiko Motoki, Koichiro Kuwahara, the I-PAD investigators

Published in: Heart and Vessels | Issue 8/2023

Login to get access

Abstract

Peripheral artery disease (PAD) is commonly caused by atherosclerosis and has an unfavorable prognosis. Complete revascularization (CR) of the coronary artery reduces the risk of major adverse cardiovascular event (MACE) in patients with coronary artery disease (CAD). However, the impact of CR in patients with PAD has not been established to date. Therefore, we evaluated the impact of CR of CAD on the five-year clinical outcomes in patients with PAD. This study was based on a prospective, multicenter, observational registry in Japan. We enrolled 366 patients with PAD undergoing endovascular treatment. The primary endpoint was MACE, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. After excluding ineligible patients, 96 and 68 patients received complete revascularization of the coronary artery (CR group) and incomplete revascularization of the coronary artery (ICR group), respectively. Freedom from MACE in the CR group was significantly higher than in the ICR group at 5 years (66.7% vs 46.0%, p < 0.01). Multivariate analysis revealed that CR emerged as an independent predictor of MACE (Hazard ratio: 0.56, 95% confidential interval: 0.34–0.94, p = 0.03). CR of CAD was significantly associated with improved clinical outcomes in patients with PAD undergoing endovascular treatment.
Literature
1.
2.
go back to reference Selvin E, Erlinger TP (2004) Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 110:738–743CrossRefPubMed Selvin E, Erlinger TP (2004) Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 110:738–743CrossRefPubMed
3.
go back to reference Vidakovic R, Schouten O, Kuiper R, Hoeks SE, Flu WJ, van Kuijk JP, Goei D, Verhagen HJ, Neskovic AN, Poldermans D (2009) The prevalence of polyvascular disease in patients referred for peripheral arterial disease. Eur J Vasc Endovasc Surg 38:435–440CrossRefPubMed Vidakovic R, Schouten O, Kuiper R, Hoeks SE, Flu WJ, van Kuijk JP, Goei D, Verhagen HJ, Neskovic AN, Poldermans D (2009) The prevalence of polyvascular disease in patients referred for peripheral arterial disease. Eur J Vasc Endovasc Surg 38:435–440CrossRefPubMed
4.
go back to reference Hur DJ, Kizilgul M, Aung WW, Roussillon KC, Keeley EC (2012) Frequency of coronary artery disease in patients undergoing peripheral artery disease surgery. Am J Cardiol 110:736–740CrossRefPubMedPubMedCentral Hur DJ, Kizilgul M, Aung WW, Roussillon KC, Keeley EC (2012) Frequency of coronary artery disease in patients undergoing peripheral artery disease surgery. Am J Cardiol 110:736–740CrossRefPubMedPubMedCentral
5.
go back to reference Ishihara T, Iida O, Tosaka A, Soga Y, Sakamoto Y, Hirano K, Nanto S, Uematsu M (2013) Severity of coronary artery disease affects prognosis of patients with peripheral artery disease. Angiology 64:417–422CrossRefPubMed Ishihara T, Iida O, Tosaka A, Soga Y, Sakamoto Y, Hirano K, Nanto S, Uematsu M (2013) Severity of coronary artery disease affects prognosis of patients with peripheral artery disease. Angiology 64:417–422CrossRefPubMed
6.
go back to reference Bhatt DL, Peterson ED, Harrington RA, Ou FS, Cannon CP, Gibson CM, Kleiman NS, Brindis RG, Peacock WF, Brener S, Menon V, Smith SC Jr, Pollack CV Jr, Gibler WB, Ohman EM, Roe MT (2009) Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. Eur Heart J 30:1195–1202CrossRefPubMed Bhatt DL, Peterson ED, Harrington RA, Ou FS, Cannon CP, Gibson CM, Kleiman NS, Brindis RG, Peacock WF, Brener S, Menon V, Smith SC Jr, Pollack CV Jr, Gibler WB, Ohman EM, Roe MT (2009) Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. Eur Heart J 30:1195–1202CrossRefPubMed
7.
go back to reference Miura T, Soga Y, Doijiri T, Aihara H, Yokoi H, Iwabuchi M, Nobuyoshi M (2013) Prevalence and clinical outocomeof polyvascular atherosclerotic disease in patients undergoing coronary intervention. Circ J 77:89–95CrossRefPubMed Miura T, Soga Y, Doijiri T, Aihara H, Yokoi H, Iwabuchi M, Nobuyoshi M (2013) Prevalence and clinical outocomeof polyvascular atherosclerotic disease in patients undergoing coronary intervention. Circ J 77:89–95CrossRefPubMed
8.
go back to reference Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES (2013) Outcomes after complete versus incomplete revascularization of patients with multi vessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol 62:1421–1431CrossRefPubMed Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES (2013) Outcomes after complete versus incomplete revascularization of patients with multi vessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol 62:1421–1431CrossRefPubMed
9.
go back to reference Hannan EL, Wu C, Walford G, Holmes DR, Jones RH, Sharma S, King SB (2009) Incomplete revascularization in the era of drug-eluting stents: impact on adverse outcomes. JACC Cardiovasc Interv 2:17–25CrossRefPubMed Hannan EL, Wu C, Walford G, Holmes DR, Jones RH, Sharma S, King SB (2009) Incomplete revascularization in the era of drug-eluting stents: impact on adverse outcomes. JACC Cardiovasc Interv 2:17–25CrossRefPubMed
10.
go back to reference Ijsselmuiden AJJ, Ezechiels JP, Westendorp ICD, Tijssen JG, Kiemeneij F, Slagboom T, Wieken RVD, Tangelder G, Serruys PW, Laarman G (2004) Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. Am Heart J 148:467–474CrossRefPubMed Ijsselmuiden AJJ, Ezechiels JP, Westendorp ICD, Tijssen JG, Kiemeneij F, Slagboom T, Wieken RVD, Tangelder G, Serruys PW, Laarman G (2004) Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. Am Heart J 148:467–474CrossRefPubMed
11.
go back to reference Généreux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O, Parise KXH, Mehran R, Serrys PW, Stone GW (2012) Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 59:2165–2174CrossRefPubMedPubMedCentral Généreux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O, Parise KXH, Mehran R, Serrys PW, Stone GW (2012) Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 59:2165–2174CrossRefPubMedPubMedCentral
12.
go back to reference Harada M, Miura T, Kobayashi T, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Hashizume N, Ebisawa S, Miyashita Y, Ikeda U (2017) Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: a sub-analysis of the SHINANO registry. Int J Cardiol 230:413–419CrossRefPubMed Harada M, Miura T, Kobayashi T, Kobayashi H, Kobayashi M, Nakajima H, Kimura H, Akanuma H, Mawatari E, Sato T, Hotta S, Kamiyoshi Y, Maruyama T, Watanabe N, Eisawa T, Hashizume N, Ebisawa S, Miyashita Y, Ikeda U (2017) Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: a sub-analysis of the SHINANO registry. Int J Cardiol 230:413–419CrossRefPubMed
13.
go back to reference Généreux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O, Xu K, Parise H, Roxana Mehran PW, Serruys GW, Stone, (2012) Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 59:2165–2174CrossRefPubMedPubMedCentral Généreux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O, Xu K, Parise H, Roxana Mehran PW, Serruys GW, Stone, (2012) Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 59:2165–2174CrossRefPubMedPubMedCentral
14.
go back to reference Kern M (2009) What is the SYNTAX score and how should we use it? Cath Lab Digest 17:8 Kern M (2009) What is the SYNTAX score and how should we use it? Cath Lab Digest 17:8
15.
go back to reference Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction; Authors/Task Force Members Chairpersons, Thygesen K, Alpert JS, White HD; Biomarker Subcommittee, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA; ECG Subcommittee, Chaitman BR, Clemmensen PM, Johanson P, Hod H; Imaging Subcommittee, Underwood R, Bax JJ, Bonow JJ, Pinto F, Gibbons RJ; Classification Subcommittee, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW; Intervention Subcommittee, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J; Trials & Registries Subcommittee, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML; Trials & Registries Subcommittee, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G; Trials & Registries Subcommittee, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D; Trials & Registries Subcommittee, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S; ESC Committee for Practice Guidelines (CPG), Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S; Document Reviewers, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR (2012) Third universal definition of myocardial infarction. J Am Coll Cardial 60: 1581–1598 Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction; Authors/Task Force Members Chairpersons, Thygesen K, Alpert JS, White HD; Biomarker Subcommittee, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA; ECG Subcommittee, Chaitman BR, Clemmensen PM, Johanson P, Hod H; Imaging Subcommittee, Underwood R, Bax JJ, Bonow JJ, Pinto F, Gibbons RJ; Classification Subcommittee, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW; Intervention Subcommittee, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J; Trials & Registries Subcommittee, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML; Trials & Registries Subcommittee, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G; Trials & Registries Subcommittee, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D; Trials & Registries Subcommittee, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S; ESC Committee for Practice Guidelines (CPG), Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S; Document Reviewers, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR (2012) Third universal definition of myocardial infarction. J Am Coll Cardial 60: 1581–1598
16.
go back to reference Brosi P, Baumgartner I, Silvestro A, Do DD, Mahler F, Triller J, Diehm N (2005) Below-the-knee angioplasty in patients with end-stage renal disease. J Endovasc Ther 12:704–713CrossRefPubMed Brosi P, Baumgartner I, Silvestro A, Do DD, Mahler F, Triller J, Diehm N (2005) Below-the-knee angioplasty in patients with end-stage renal disease. J Endovasc Ther 12:704–713CrossRefPubMed
17.
go back to reference Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, Caminiti M, Curci V, Quarantiello A, Lupattelli T, Morabito A (2009) Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care 32:822–827CrossRefPubMedPubMedCentral Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, Caminiti M, Curci V, Quarantiello A, Lupattelli T, Morabito A (2009) Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care 32:822–827CrossRefPubMedPubMedCentral
18.
go back to reference Nishikawa K, Ebisawa S, Miura T, Kato T, Yusuke K, Abe N, Yokota D, Yanagisawa T, Senda K, Wakabayashi T, Oyama Y, Karube K, Itagaki T, Yui H, Maruyama S, Nagae A, Sakai T, Okina Y, Nakazawa S, Tsukada S, Saigusa T, Okada A, Motoki H, Kagoshima M, Kuwahara K (2022) Impact of frailty and age on clinical outcomes in patients who underwent endovascular therapy. J Endvasc Ther 29:845–854CrossRef Nishikawa K, Ebisawa S, Miura T, Kato T, Yusuke K, Abe N, Yokota D, Yanagisawa T, Senda K, Wakabayashi T, Oyama Y, Karube K, Itagaki T, Yui H, Maruyama S, Nagae A, Sakai T, Okina Y, Nakazawa S, Tsukada S, Saigusa T, Okada A, Motoki H, Kagoshima M, Kuwahara K (2022) Impact of frailty and age on clinical outcomes in patients who underwent endovascular therapy. J Endvasc Ther 29:845–854CrossRef
19.
go back to reference Itagaki T, Ebisawa S, Otagiri K, Kato T, Miura T, Kanzaki Y, Abe N, Yokota D, Yanagisawa T, Senda K, Okina Y, Wakabayashi T, Oyama Y, Karube K, Machida K, Takeuchi T, Saigusa T, Motoki H, Kitabayashi H, Kuwahara K (2021) Body composition and mortality in patients undergoing endovascular treatment for peripheral artery disease. Heart Vessels 36:1830–1840CrossRefPubMed Itagaki T, Ebisawa S, Otagiri K, Kato T, Miura T, Kanzaki Y, Abe N, Yokota D, Yanagisawa T, Senda K, Okina Y, Wakabayashi T, Oyama Y, Karube K, Machida K, Takeuchi T, Saigusa T, Motoki H, Kitabayashi H, Kuwahara K (2021) Body composition and mortality in patients undergoing endovascular treatment for peripheral artery disease. Heart Vessels 36:1830–1840CrossRefPubMed
20.
go back to reference Fujihara M, Higashimori A, Kato Y, Taniguchi H, Iwasaki Y, Amano T, Sumiyoshi A, Nishiya D, Yokoi Y (2016) Nitinol stent implantation femoropopliteal disease in patients on hemodialysis: result of 3-year retrospective multicenter APOLLON study. Heart Vessels 31:1476–1483CrossRefPubMed Fujihara M, Higashimori A, Kato Y, Taniguchi H, Iwasaki Y, Amano T, Sumiyoshi A, Nishiya D, Yokoi Y (2016) Nitinol stent implantation femoropopliteal disease in patients on hemodialysis: result of 3-year retrospective multicenter APOLLON study. Heart Vessels 31:1476–1483CrossRefPubMed
21.
go back to reference Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mils JL, Ricco JB, Suresh KR, Murad MH, GVG writing Group (2019) Global vascular guidelines on the management of limb-threatening ischemia. J Vasc Surg 69:3s–125sCrossRefPubMedPubMedCentral Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mils JL, Ricco JB, Suresh KR, Murad MH, GVG writing Group (2019) Global vascular guidelines on the management of limb-threatening ischemia. J Vasc Surg 69:3s–125sCrossRefPubMedPubMedCentral
22.
go back to reference Samsky MD, Hellkamp A, Hiatt WR, Fowkes GR, Baumgartner I, Berger JS, Katona MBG, Mahaffey PKW, Norgren L, Blomster JI, Rockhold FW, De Vore AD, Patel MHSMR, Jones WS (2021) Association of heart failure with outcomes among patients with peripheral artery disease: insights from EUCLID. J Am Heart Assoc 10:e018684CrossRefPubMedPubMedCentral Samsky MD, Hellkamp A, Hiatt WR, Fowkes GR, Baumgartner I, Berger JS, Katona MBG, Mahaffey PKW, Norgren L, Blomster JI, Rockhold FW, De Vore AD, Patel MHSMR, Jones WS (2021) Association of heart failure with outcomes among patients with peripheral artery disease: insights from EUCLID. J Am Heart Assoc 10:e018684CrossRefPubMedPubMedCentral
23.
go back to reference Melby SJ, Saint LL, Balsara K, Itoh A, Lawton JS, Maniar H, Pasque MK, Damiano RJ Jr, Moon MR (2016) Complete coronary revascularization improves survival in octogenarians. Ann Thorac Surg 102:505–511CrossRefPubMed Melby SJ, Saint LL, Balsara K, Itoh A, Lawton JS, Maniar H, Pasque MK, Damiano RJ Jr, Moon MR (2016) Complete coronary revascularization improves survival in octogenarians. Ann Thorac Surg 102:505–511CrossRefPubMed
24.
go back to reference Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, Carlo MD, Debus S, Klein CE, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I (2018) ESC Guidelines on the diagnosis and treatment of peripheral arterial disease, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO) the task force for the diagnosis and treatment of peripheral arterial disease of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39:763–816CrossRefPubMed Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, Carlo MD, Debus S, Klein CE, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I (2018) ESC Guidelines on the diagnosis and treatment of peripheral arterial disease, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO) the task force for the diagnosis and treatment of peripheral arterial disease of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39:763–816CrossRefPubMed
Metadata
Title
Association between complete revascularization of the coronary artery and clinical outcomes in peripheral artery disease: a sub-analysis of the I-PAD Nagano registry
Authors
Tamon Kato
Yasushi Ueki
Masatoshi Minamisawa
Takashi Miura
Yushi Oyama
Naoto Hashizume
Daisuke Yokota
Minami Taki
Keisuke Senda
Yoshiteru Okina
Tadamasa Wakabayashi
Koki Fujimori
Kenichi Karube
Takahiro Sakai
Hidetomo Nomi
Hisanori Yui
Yusuke Kanzaki
Keisuke Machida
Shusaku Maruyama
Ayumu Nagae
Tatsuya Saigusa
Soichiro Ebisawa
Ayako Okada
Hirohiko Motoki
Koichiro Kuwahara
the I-PAD investigators
Publication date
13-04-2023
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 8/2023
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-023-02251-y

Other articles of this Issue 8/2023

Heart and Vessels 8/2023 Go to the issue