Long term prognosis in patients with peripheral arterial disease treated with antiplatelet agents

Objective. To determine the fatal and non-fatal cardiovascular event rate in patients with intermittent claudication treated with antiplatelet agents. Methods and design. Patients with PAD-II stage Fontaine (n = 223) and sex and age matched controls (n = 446) were followed up from 1974 to 1998. All patients were treated with antiplatelet agents (aspirin, 325 mg once daily or ticlopidine, 250 mg twice daily) and for risk factors, if present. The end points were death for any cause (vascular event, cancer, and others) and non-fatal vascular events (myocardial infarction, ischemic/hemorrhagic stroke, and leg amputation). Results. PAD patients had a significantly higher mortality rate than controls (3.99 vs. 2.53 deaths for 100 patients per year, respectively), cancer (mostly lung, stomach and colon) and vascular mortality accounted for such difference. The incidence of non-fatal vascular events was three times higher in patients than in controls (1.7 vs. 0.56, 100 patients per year, respectively, p < 0.05) even considering amputation separately (0.28 vs. 0.00, 100 patients per year, p < 0.05). No difference between patients treated with aspirin or ticlopidine could be found in both end points. Conclusions. Vascular mortality and morbidity, despite the use of antiplatelet agents, are still higher than sex and age matched controls; however, the commonest cause of death is cancer.