Prevalence and Severity of Coronary Artery Disease in Patients with Symptomatic Lower Limb Peripheral Arterial Disease

Abstract

Introduction: The presence of combined lower extremity peripheral arterial disease (PAD)
and coronary artery disease (CAD) is associated with nearly doubled all-cause mortality.
However diagnosis of CAD in PAD patients remains difficult because of absence of symptoms
due to reduced physical activity. Data regarding the coexistence of CAD in lower limb PAD
patients are scarce. So, the aim of this study was to assess prevalence and severity of coronary
artery disease in patients with symptomatic lower limb PAD.
Methods: From December 2012 to February 2015, all consecutive patients with PAD
undergoing invasive peripheral and coronary angiography were included. Patients with the
history of percutaneous or surgical interventions for lower limb PAD or for coronary arteries,
recent (≤ 3 months) acute limb ischemia or acute myocardial infarction were excluded.
Significant CAD was defined as ≥50% diameter stenosis in atleast one major epicardial
coronary artery. Severity of CAD was assessed by Gensini score.
Results: Total 151 patients were included. Mean age was 57.26±9.74 years. The overall
prevalence of CAD was 74.83%. Among CAD patients, 46.4% were asymptomatic and
majority of patients were having multivessel involvement (77.87%). Diabetes and dyslipidemia
were significantly associated with a higher prevalence of CAD (p <0.001 for both). Though
not statistically significant, multivessel CAD was more prevalent in patients with aortoiliac
iliac disease in comparison to patients with non-aortoiliac disease. The prevalence of
multivessel CAD was significantly high in extensive PAD (≥3 lesions irrespective of site) in
comparison to limited PAD. (p=0.02) Severity of CAD assessed Gensini score doesn’t show
significant correlation with pattern or severity of PAD.
Conclusion: Overall, there is high prevalence of CAD in patients with symptomatic lower limb
PAD. About 50% of CAD are asymptomatic. Diabetes mellitus and dyslipidemia are the
independent risk factor for development of CAD. PAD patients are more prone for multivessel
CAD.