Vascular http://vas.sagepub.com/
Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease Ahmet Çagri Aykan, Engin Hatem, Can Yücel Karabay, Ilker Gül, Tayyar Gökdeniz, Ezgi Kalaycioglu, Turhan Turan, Faruk Kara, Ahmet Oguz Arslan, Ihsan Dursun, Mustafa Çetin and Ahmet Güler Vascular published online 10 September 2014 DOI: 10.1177/1708538114550738 The online version of this article can be found at: http://vas.sagepub.com/content/early/2014/09/10/1708538114550738
Published by: http://www.sagepublications.com
Additional services and information for Vascular can be found at: Email Alerts: http://vas.sagepub.com/cgi/alerts Subscriptions: http://vas.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Sep 10, 2014 What is This?
Downloaded from vas.sagepub.com at PORTLAND STATE UNIV on September 14, 2014
XML Template (2014) [2.9.2014–5:47pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/VASJ/Vol00000/140068/APPFile/SG-VASJ140068.3d
(VAS)
[1–8] [PREPRINTER stage]
Vascular OnlineFirst, published on September 10, 2014 as doi:10.1177/1708538114550738
Original Article
Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease
Vascular 0(0) 1–8 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1708538114550738 vas.sagepub.com
Ahmet C ¸ ag˘rı Aykan1, Engin Hatem1, Can Yu¨cel Karabay2, ˙Ilker Gu¨l1, Tayyar Go¨kdeniz1, Ezgi Kalaycıog˘lu1, Turhan Turan1, Faruk Kara1, Ahmet Og˘uz Arslan1, ˙Ihsan Dursun1, Mustafa C ¸ etin1 and Ahmet Gu¨ler2
Abstract We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r ¼ 0.495, p < 0.001). In multivariate regression analysis male sex (B ¼ 0.169, p < 0.001, CI95% ¼ 0.270–0.735), Log10 SYNTAX score (B ¼ 0.282, p < 0.001, CI95% ¼ 0.431– 0.782), Log10 creatinine (B ¼ 0.081, p ¼ 0.036, CI95% ¼ 0.043–1.239), low-density lipoprotein (B ¼ 0.114, p ¼ 0.003, CI95% ¼ 0.001–0.006) and high-density lipoprotein (B ¼ 0.360, p < 0.001, CI95% ¼ 0.063 to 0.041) were the independent predictors of Trans Atlantic Inter-Society Consensus II class. We have shown that patients with complex peripheral artery disease had complex coronary artery disease.
Keywords Peripheral, artery, coronary, angiography, Trans Atlantic Inter-Society Consensus, SYNTAX
Introduction Lower extremity peripheral artery disease (PAD) affects the considerable percentage of the population. Trans Atlantic Inter-Society Consensus II (TASC II) classification is an internationally derived, collaboratively created consensus definition that is dedicated for the assessment of peripheral artery disease (PAD) according to anatomic distribution, number and nature of lesions (stenosis, occlusion) in combination with published outcomes for intervention.1,2 PAD is generally a consequence of systemic atherosclerotic disease processes that affect multiple arterial circulations. The major cause of lower extremity PAD is atherosclerosis. Risk factors for atherosclerosis such as cigarette smoking, diabetes, hyperlipidemia, hypertension and hyperhomocysteinemia are common among patients with PAD.1,2
Coronary artery disease (CAD) is common among patients with PAD. PAD is associated with an increased risk of cardiovascular and all-cause mortality.3,4 This is believed to be due to the higher prevalence of cardiac risk factors among patients with PAD.5 But increment of cardiovascular events in patients with PAD may also be associated with increased complexity 1 Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey 2 Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
Corresponding author: Ahmet C ¸ ag˘rı Aykan, Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Sog˘uksu Mahallesi, C ¸ amlık Caddesi, 61040 Trabzon, Turkey. Email: [email protected]
Downloaded from vas.sagepub.com at PORTLAND STATE UNIV on September 14, 2014
XML Template (2014) [2.9.2014–5:47pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/VASJ/Vol00000/140068/APPFile/SG-VASJ140068.3d
(VAS)
[1–8] [PREPRINTER stage]
2
Vascular 0(0)
of CAD. The SYNTAX score (SS) is a comprehensive angiographic scoring system dedicated for the assessment of complexity and severity of coronary artery anatomy and lesion characteristics.6,7 SS is a valuable marker of major adverse cardiovascular events and cardiovascular mortality.7 However, the data regarding the association of the complexity of CAD with the complexity of PAD is lacking. The aim of this study is to evaluate the relationship between CAD complexity evaluated with SS and PAD complexity evaluated with TASC-II classification.
Material and methods Patients and study design This cross sectional retrospective study enrolled 449 patients with peripheral artery disease who underwent peripheral angiography along with coronary angiography (CAG) between June 2011 and October 2013. Informed consent was obtained from all subjects, and the investigation confirms to the principles outlined in the Declaration of Helsinki. The study protocol was approved by ethics committee. We routinely perform CAG for patients with PAD because half of patients with PAD had CAD and they often have no chest symptoms because of the limitation of cardiac load due to severe intermittent claudication. Additionally, we also performed routine peripheral angiography to patients when we encountered a problem during advancing the catheters or introducer sheaths through transfemoral route. Patients’ previous peripheral or coronary artery revascularizations, acute coronary syndrome, vasculitis, nonatherosclerotic stenosis, acute limp threatening ischemia were excluded from the study. We also excluded patients with known or suspected infectious or inflammatory conditions or need of urgent coronary angiography and intervention. Hypertension was defined by a previous diagnosis of hypertension or the presence of SBP 140 mmHg or DBP 90 mmHg (mean of two consecutive measurements). Diabetes was defined as fasting plasma glucose 126 mg/dL or plasma glucose level 200 mg/dL 2 hours after the 75-mg oral glucose tolerance test or symptoms of hyperglycemia accompanied by casual plasma glucose 200 mg/dL or HbA1C 6.5% or patients using antidiabetic medications. Hyperlipidemia was defined as low-density lipoprotein (LDL) cholesterol 160 mg/dL or statin usage. Chronic renal failure (CRF) was defined as estimated glomerular filtration rate (GFR) according to modification of diet in renal disease formula (MDRD)
Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease Ahmet Çagri Aykan, Engin Hatem, Can Yücel Karabay, Ilker Gül, Tayyar Gökdeniz, Ezgi Kalaycioglu, Turhan Turan, Faruk Kara, Ahmet Oguz Arslan, Ihsan Dursun, Mustafa Çetin and Ahmet Güler Vascular published online 10 September 2014 DOI: 10.1177/1708538114550738 The online version of this article can be found at: http://vas.sagepub.com/content/early/2014/09/10/1708538114550738
Published by: http://www.sagepublications.com
Additional services and information for Vascular can be found at: Email Alerts: http://vas.sagepub.com/cgi/alerts Subscriptions: http://vas.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Sep 10, 2014 What is This?
Downloaded from vas.sagepub.com at PORTLAND STATE UNIV on September 14, 2014
XML Template (2014) [2.9.2014–5:47pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/VASJ/Vol00000/140068/APPFile/SG-VASJ140068.3d
(VAS)
[1–8] [PREPRINTER stage]
Vascular OnlineFirst, published on September 10, 2014 as doi:10.1177/1708538114550738
Original Article
Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease
Vascular 0(0) 1–8 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1708538114550738 vas.sagepub.com
Ahmet C ¸ ag˘rı Aykan1, Engin Hatem1, Can Yu¨cel Karabay2, ˙Ilker Gu¨l1, Tayyar Go¨kdeniz1, Ezgi Kalaycıog˘lu1, Turhan Turan1, Faruk Kara1, Ahmet Og˘uz Arslan1, ˙Ihsan Dursun1, Mustafa C ¸ etin1 and Ahmet Gu¨ler2
Abstract We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r ¼ 0.495, p < 0.001). In multivariate regression analysis male sex (B ¼ 0.169, p < 0.001, CI95% ¼ 0.270–0.735), Log10 SYNTAX score (B ¼ 0.282, p < 0.001, CI95% ¼ 0.431– 0.782), Log10 creatinine (B ¼ 0.081, p ¼ 0.036, CI95% ¼ 0.043–1.239), low-density lipoprotein (B ¼ 0.114, p ¼ 0.003, CI95% ¼ 0.001–0.006) and high-density lipoprotein (B ¼ 0.360, p < 0.001, CI95% ¼ 0.063 to 0.041) were the independent predictors of Trans Atlantic Inter-Society Consensus II class. We have shown that patients with complex peripheral artery disease had complex coronary artery disease.
Keywords Peripheral, artery, coronary, angiography, Trans Atlantic Inter-Society Consensus, SYNTAX
Introduction Lower extremity peripheral artery disease (PAD) affects the considerable percentage of the population. Trans Atlantic Inter-Society Consensus II (TASC II) classification is an internationally derived, collaboratively created consensus definition that is dedicated for the assessment of peripheral artery disease (PAD) according to anatomic distribution, number and nature of lesions (stenosis, occlusion) in combination with published outcomes for intervention.1,2 PAD is generally a consequence of systemic atherosclerotic disease processes that affect multiple arterial circulations. The major cause of lower extremity PAD is atherosclerosis. Risk factors for atherosclerosis such as cigarette smoking, diabetes, hyperlipidemia, hypertension and hyperhomocysteinemia are common among patients with PAD.1,2
Coronary artery disease (CAD) is common among patients with PAD. PAD is associated with an increased risk of cardiovascular and all-cause mortality.3,4 This is believed to be due to the higher prevalence of cardiac risk factors among patients with PAD.5 But increment of cardiovascular events in patients with PAD may also be associated with increased complexity 1 Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey 2 Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
Corresponding author: Ahmet C ¸ ag˘rı Aykan, Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Sog˘uksu Mahallesi, C ¸ amlık Caddesi, 61040 Trabzon, Turkey. Email: [email protected]
Downloaded from vas.sagepub.com at PORTLAND STATE UNIV on September 14, 2014
XML Template (2014) [2.9.2014–5:47pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/VASJ/Vol00000/140068/APPFile/SG-VASJ140068.3d
(VAS)
[1–8] [PREPRINTER stage]
2
Vascular 0(0)
of CAD. The SYNTAX score (SS) is a comprehensive angiographic scoring system dedicated for the assessment of complexity and severity of coronary artery anatomy and lesion characteristics.6,7 SS is a valuable marker of major adverse cardiovascular events and cardiovascular mortality.7 However, the data regarding the association of the complexity of CAD with the complexity of PAD is lacking. The aim of this study is to evaluate the relationship between CAD complexity evaluated with SS and PAD complexity evaluated with TASC-II classification.
Material and methods Patients and study design This cross sectional retrospective study enrolled 449 patients with peripheral artery disease who underwent peripheral angiography along with coronary angiography (CAG) between June 2011 and October 2013. Informed consent was obtained from all subjects, and the investigation confirms to the principles outlined in the Declaration of Helsinki. The study protocol was approved by ethics committee. We routinely perform CAG for patients with PAD because half of patients with PAD had CAD and they often have no chest symptoms because of the limitation of cardiac load due to severe intermittent claudication. Additionally, we also performed routine peripheral angiography to patients when we encountered a problem during advancing the catheters or introducer sheaths through transfemoral route. Patients’ previous peripheral or coronary artery revascularizations, acute coronary syndrome, vasculitis, nonatherosclerotic stenosis, acute limp threatening ischemia were excluded from the study. We also excluded patients with known or suspected infectious or inflammatory conditions or need of urgent coronary angiography and intervention. Hypertension was defined by a previous diagnosis of hypertension or the presence of SBP 140 mmHg or DBP 90 mmHg (mean of two consecutive measurements). Diabetes was defined as fasting plasma glucose 126 mg/dL or plasma glucose level 200 mg/dL 2 hours after the 75-mg oral glucose tolerance test or symptoms of hyperglycemia accompanied by casual plasma glucose 200 mg/dL or HbA1C 6.5% or patients using antidiabetic medications. Hyperlipidemia was defined as low-density lipoprotein (LDL) cholesterol 160 mg/dL or statin usage. Chronic renal failure (CRF) was defined as estimated glomerular filtration rate (GFR) according to modification of diet in renal disease formula (MDRD)
