The General Prognosis of Patients With Peripheral Arterial Disease Differs According to the Disease Localization

Objectives The purpose of this study was to assess the general prognosis of patients with peripheral arterial disease (PAD) according to the disease localization. Background PAD is associated with poor cardiovascular disease prognosis. However, it is unknown whether the general prognosis could differ according to PAD topography. Methods Data for all patients who underwent a first digital subtraction angiography of their lower limbs between January 2000 and December 2005 at our hospital were reviewed. Arterial stenoses >= 50% were located by 2 experienced vascular physicians. The following events were collected until April 2007: death, nonfatal myocardial infarction or stroke, and coronary or carotid revascularization. The primary outcome combined all these events. Results We studied 400 PAD patients (age 68.3 +/- 12.3 years, 77.5% men). Aortoiliac disease (proximal PAD) and infrailiac disease (distal PAD) were noted in 211 (52.8%) and 344 (86.0%) 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 < 0.05). During the follow-up period (34 +/- 23 months), the event-free survival curves differed according to the PAD localization (p < 0.03). 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 < 0.002 vs. distal PAD). Conclusions This is the first study 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. (J Am Coll Cardiol 2010; 55: 898-903) (C) 2010 by the American College of Cardiology Foundation