Clinical outcomes of patients with critical limb ischemia who undergo routine coronary angiography and subsequent percutaneous coronary intervention

Michael S. Lee, Seung-Woon Rha, Seung-Kyu Han, Byoung Geol Choi, Se Yeon Choi, Yoonjee Park, Raghu Akkala, Hu Li, Sung Il Im, Ji Bak Kim, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA). METHODS: Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis. RESULTS: Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P≤.45), myocardial infarction (1.1% vs 0%; P≤.31), and PCI (4.7% vs 1.1%; P≤.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P≤.86), target lesion revascularization (13.7% vs 14.1%; P≤.94), and amputation (19.1% vs 16.4%; P≤.60). CONCLUSION: A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.

Original languageEnglish
Pages (from-to)213-217
Number of pages5
JournalJournal of Invasive Cardiology
Volume27
Issue number4
Publication statusPublished - 2015 Apr 1

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Percutaneous Coronary Intervention
Coronary Angiography
Ischemia
Coronary Artery Disease
Extremities
Angioplasty
Pathologic Constriction
Arteries
Cerebrovascular Disorders
Amputation
Myocardial Infarction
Mortality

Keywords

  • coronary artery disease
  • critical limb ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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Clinical outcomes of patients with critical limb ischemia who undergo routine coronary angiography and subsequent percutaneous coronary intervention. / Lee, Michael S.; Rha, Seung-Woon; Han, Seung-Kyu; Choi, Byoung Geol; Choi, Se Yeon; Park, Yoonjee; Akkala, Raghu; Li, Hu; Im, Sung Il; Kim, Ji Bak; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo.

In: Journal of Invasive Cardiology, Vol. 27, No. 4, 01.04.2015, p. 213-217.

Research output: Contribution to journalArticle

Lee, Michael S. ; Rha, Seung-Woon ; Han, Seung-Kyu ; Choi, Byoung Geol ; Choi, Se Yeon ; Park, Yoonjee ; Akkala, Raghu ; Li, Hu ; Im, Sung Il ; Kim, Ji Bak ; Lee, Sunki ; Na, Jin Oh ; Choi, Cheol Ung ; Lim, Hong Euy ; Kim, Jin Won ; Kim, Eung Ju ; Park, Chang Gyu ; Seo, Hong Seog ; Oh, Dong Joo. / Clinical outcomes of patients with critical limb ischemia who undergo routine coronary angiography and subsequent percutaneous coronary intervention. In: Journal of Invasive Cardiology. 2015 ; Vol. 27, No. 4. pp. 213-217.
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AU - Lee, Michael S.

AU - Rha, Seung-Woon

AU - Han, Seung-Kyu

AU - Choi, Byoung Geol

AU - Choi, Se Yeon

AU - Park, Yoonjee

AU - Akkala, Raghu

AU - Li, Hu

AU - Im, Sung Il

AU - Kim, Ji Bak

AU - Lee, Sunki

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Lim, Hong Euy

AU - Kim, Jin Won

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

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N2 - BACKGROUND: Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA). METHODS: Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis. RESULTS: Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P≤.45), myocardial infarction (1.1% vs 0%; P≤.31), and PCI (4.7% vs 1.1%; P≤.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P≤.86), target lesion revascularization (13.7% vs 14.1%; P≤.94), and amputation (19.1% vs 16.4%; P≤.60). CONCLUSION: A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.

AB - BACKGROUND: Critical limb ischemia (CLI) is associated with a high risk of cardiovascular ischemic events. We assessed the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA). METHODS: Of a total 286 consecutive CLI patients treated by PTA, 252 patients who underwent coronary angiography before or after PTA were enrolled. Coronary artery disease (CAD) was defined as angiographic stenosis ≥50% and significant CAD as ≥70% stenosis. RESULTS: Of the 252 patients with CLI who underwent coronary angiography, a total of 167 patients (66.3%) had CAD and 85 patients (33.7%) did not have CAD. Patients in the CAD group were older, had a higher prevalence of diabetes and cerebrovascular disease, and had a lower mean ejection fraction. In the CAD group, of the 145 patients with significant CAD, percutaneous coronary intervention (PCI) was performed in 114 patients (78.6%). At 1 year, the CAD and non-CAD groups had no statistically significant differences in mortality (7.1% vs 4.7%; P≤.45), myocardial infarction (1.1% vs 0%; P≤.31), and PCI (4.7% vs 1.1%; P≤.31). These outcomes were similar after the adjustment of baseline confounders. At 1 year, the CAD and non-CAD groups had similar rates of repeat PTA (16.7% vs 17.6%; P≤.86), target lesion revascularization (13.7% vs 14.1%; P≤.94), and amputation (19.1% vs 16.4%; P≤.60). CONCLUSION: A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for these patients who have high risk for severe CAD. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.

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