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Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging

Kaiming Wang, Tali Sharir, M. Timothy Hauser, Sharmila Dorbala, Marcelo Di Carli, Mathews B. Fish, Terrence D. Ruddy, Timothy Bateman, Andrew J. Einstein, Philipp A. Kaufmann, Edward J. Miller, Albert J. Sinusas, Wanda Acampa, Julian Halcox Orcid Logo, Monica Casanova da Silva Martins, Joanna X. Liang, Valerie Builoff, Damini Dey, Daniel S. Berman, Robert J.H. Miller, Piotr J. Slomka

Canadian Journal of Cardiology, Volume: 41, Issue: 10, Pages: 1936 - 1945

Swansea University Authors: Julian Halcox Orcid Logo, Monica Casanova da Silva Martins

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DOI (Published version): 10.1016/j.cjca.2025.05.002

Abstract

Background: Coronary artery disease (CAD) and peripheral artery disease (PAD) are often regarded as analogous risk factors for major adverse cardiovascular events (MACE), given their shared pathophysiology. We aimed to investigate whether the elevated MACE risk in PAD is driven by myocardial perfusi...

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Published in: Canadian Journal of Cardiology
ISSN: 0828-282X 1916-7075
Published: Elsevier BV 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70098
Abstract: Background: Coronary artery disease (CAD) and peripheral artery disease (PAD) are often regarded as analogous risk factors for major adverse cardiovascular events (MACE), given their shared pathophysiology. We aimed to investigate whether the elevated MACE risk in PAD is driven by myocardial perfusion abnormalities or through other PAD-specific mediators. Methods: We analyzed 45,252 patients from an international, multicentre registry who underwent SPECT myocardial perfusion imaging, excluding those with early coronary revascularization (< 90 days). Myocardial perfusion abnormalities were quantified using total perfusion deficit (TPD). MACE was defined as all-cause mortality, unstable angina admission, myocardial infarction, or late coronary revascularization. PAD was defined using questionnaires or review of electronic medical records. Propensity-score matching was used to select balanced groups of patients with and without PAD. Results: During a median follow-up of 3.6 years (interquartile range [IQR]: 2.6-4.8 years), 5932 patients (13.7%) experienced at least 1 MACE. Compared with patients with neither disease, isolated history of CAD (adjusted hazard ratio [aHR], 1.92; 95% confidence interval [CI], 1.80-2.05) conferred a similar MACE risk as concomitant history of CAD and PAD (aHR, 1.57; 95% CI, 1.44-1.71) and greater risk than isolated history of PAD (aHR, 1.20; 95% CI, 1.09-1.32; P < 0.001). After propensity-score matching, history of PAD alone was not independently associated with increased MACE risk (P = 0.064). Conclusions: Although patients with PAD often have concomitant CAD and greater myocardial perfusion abnormalities, PAD itself was not linked to higher risk of MACE after adjusting for these factors. These findings highlight the importance of assessing myocardial ischemic burden in PAD for risk stratification and prompt initiation of disease-modifying therapies.
College: Faculty of Medicine, Health and Life Sciences
Funders: This research was supported in part by grants R01HL089765 and R35HL161195 from the National Heart, Lung, and Blood Institute at the National Institutes of Health (PI: Dr Slomka).
Issue: 10
Start Page: 1936
End Page: 1945

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