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

• Published in: The Journal of invasive cardiology 2015-04, Vol.27 (4), p.213-217
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Aged; Amputation; Angioplasty; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - mortality; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - epidemiology; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Critical Illness; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Female; Humans; Ischemia - therapy; Leg - blood supply; Limb Salvage; Male; Middle Aged; Percutaneous Coronary Intervention; Prevalence; Risk Factors; Stroke Volume; Treatment Outcome
• ISSN: 1557-2501

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). 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. 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). 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.