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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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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 (&lt; 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 &lt; 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.</abstract><type>Journal Article</type><journal>Canadian Journal of Cardiology</journal><volume>41</volume><journalNumber>10</journalNumber><paginationStart>1936</paginationStart><paginationEnd>1945</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0828-282X</issnPrint><issnElectronic>1916-7075</issnElectronic><keywords/><publishedDay>12</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-05-12</publishedDate><doi>10.1016/j.cjca.2025.05.002</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><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).</funders><projectreference/><lastEdited>2025-10-22T12:19:06.3249522</lastEdited><Created>2025-08-04T09:32:42.5563580</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Kaiming</firstname><surname>Wang</surname><order>1</order></author><author><firstname>Tali</firstname><surname>Sharir</surname><order>2</order></author><author><firstname>M. Timothy</firstname><surname>Hauser</surname><order>3</order></author><author><firstname>Sharmila</firstname><surname>Dorbala</surname><order>4</order></author><author><firstname>Marcelo Di</firstname><surname>Carli</surname><order>5</order></author><author><firstname>Mathews B.</firstname><surname>Fish</surname><order>6</order></author><author><firstname>Terrence D.</firstname><surname>Ruddy</surname><order>7</order></author><author><firstname>Timothy</firstname><surname>Bateman</surname><order>8</order></author><author><firstname>Andrew J.</firstname><surname>Einstein</surname><order>9</order></author><author><firstname>Philipp A.</firstname><surname>Kaufmann</surname><order>10</order></author><author><firstname>Edward J.</firstname><surname>Miller</surname><order>11</order></author><author><firstname>Albert J.</firstname><surname>Sinusas</surname><order>12</order></author><author><firstname>Wanda</firstname><surname>Acampa</surname><order>13</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>14</order></author><author><firstname>Monica</firstname><surname>Casanova da Silva Martins</surname><order>15</order></author><author><firstname>Joanna X.</firstname><surname>Liang</surname><order>16</order></author><author><firstname>Valerie</firstname><surname>Builoff</surname><order>17</order></author><author><firstname>Damini</firstname><surname>Dey</surname><order>18</order></author><author><firstname>Daniel S.</firstname><surname>Berman</surname><order>19</order></author><author><firstname>Robert J.H.</firstname><surname>Miller</surname><order>20</order></author><author><firstname>Piotr J.</firstname><surname>Slomka</surname><order>21</order></author></authors><documents><document><filename>70098__35438__7847572824754e24819dfd3952d6786b.pdf</filename><originalFilename>70098.VOR.pdf</originalFilename><uploaded>2025-10-22T11:40:24.5382807</uploaded><type>Output</type><contentLength>2145925</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025 The Authors. 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spelling 2025-10-22T12:19:06.3249522 v2 70098 2025-08-04 Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 53b42665a15b52c5b961969b11f522c0 Monica Casanova da Silva Martins Monica Casanova da Silva Martins true false 2025-08-04 MEDS 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. Journal Article Canadian Journal of Cardiology 41 10 1936 1945 Elsevier BV 0828-282X 1916-7075 12 5 2025 2025-05-12 10.1016/j.cjca.2025.05.002 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 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). 2025-10-22T12:19:06.3249522 2025-08-04T09:32:42.5563580 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Kaiming Wang 1 Tali Sharir 2 M. Timothy Hauser 3 Sharmila Dorbala 4 Marcelo Di Carli 5 Mathews B. Fish 6 Terrence D. Ruddy 7 Timothy Bateman 8 Andrew J. Einstein 9 Philipp A. Kaufmann 10 Edward J. Miller 11 Albert J. Sinusas 12 Wanda Acampa 13 Julian Halcox 0000-0001-6926-2947 14 Monica Casanova da Silva Martins 15 Joanna X. Liang 16 Valerie Builoff 17 Damini Dey 18 Daniel S. Berman 19 Robert J.H. Miller 20 Piotr J. Slomka 21 70098__35438__7847572824754e24819dfd3952d6786b.pdf 70098.VOR.pdf 2025-10-22T11:40:24.5382807 Output 2145925 application/pdf Version of Record true © 2025 The Authors. Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. This is an open access article under the CC BY-NC-ND license. true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
spellingShingle Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
Julian Halcox
Monica Casanova da Silva Martins
title_short Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
title_full Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
title_fullStr Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
title_full_unstemmed Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
title_sort Reassessing Cardiovascular Risk in Patients With Peripheral Artery Disease Undergoing Myocardial Perfusion Imaging
author_id_str_mv 3676f695eeda169d0f8c618adf27c04b
53b42665a15b52c5b961969b11f522c0
author_id_fullname_str_mv 3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
53b42665a15b52c5b961969b11f522c0_***_Monica Casanova da Silva Martins
author Julian Halcox
Monica Casanova da Silva Martins
author2 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
Monica Casanova da Silva Martins
Joanna X. Liang
Valerie Builoff
Damini Dey
Daniel S. Berman
Robert J.H. Miller
Piotr J. Slomka
format Journal article
container_title Canadian Journal of Cardiology
container_volume 41
container_issue 10
container_start_page 1936
publishDate 2025
institution Swansea University
issn 0828-282X
1916-7075
doi_str_mv 10.1016/j.cjca.2025.05.002
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description 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.
published_date 2025-05-12T05:28:45Z
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score 11.089572

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