December 04, 2018
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Risk for revascularization, MACE elevated with polyvascular disease

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Compared with patients with peripheral artery disease alone, patients with PAD plus disease in other vascular beds had elevated risk for revascularization and MACE, according to new data from the EUCLID study.

As Cardiology Today’s Intervention previously reported, EUCLID was a trial comparing ticagrelor (Brilinta, AstraZeneca) with clopidogrel in patients with symptomatic PAD; there were no significant differences in CV events between the groups.

For the present analysis, the researchers stratified the 13,885 patients from EUCLID (median age, 66 years; 28% women) according to whether they had PAD alone (56.2%), PAD plus CAD (19%), PAD plus CVD (14.8%) or PAD plus CAD and CVD (10%). The groups were compared against each other for MACE, defined as CV death, MI and ischemic stroke; lower-extremity revascularization; acute limb ischemia; major amputation; and TIMI major bleeding. Median follow-up was 30 months.

Compared with the PAD-only group, the other three groups had elevated risk for MACE (adjusted HR for PAD plus CVD = 1.34; 95% CI, 1.15-1.57; aHR for PAD plus CAD = 1.65; 95% CI, 1.43-1.91); aHR for PAD plus CAD and CVD = 1.99; 95% CI, 1.69-2.34), J. Antonio Gutierrez, MD, MHS, from Duke Clinical Research Institute and Duke University School of Medicine, and colleagues wrote.

All three groups with polyvascular disease also had elevated risk for lower-extremity revascularization compared with the PAD-only group (aHR for PAD plus CAD = 1.17; 95% CI, 1.03-1.34; aHR for PAD plus CVD = 1.17; 95% CI, 1.02-1.35; aHR for PAD plus CAD and CVD = 1.34; 95% CI, 1.15-1.57), according to the researchers.

There was no difference between the groups in risk for acute limb ischemia, major amputation and TIMI major bleeding, Gutierrez and colleagues wrote.

“These data highlight the increased risk of CAD and CVD among patients with PAD and the need to identify potent preventive antithrombotic therapies,” the researchers wrote. – by Erik Swain

Disclosures: The study was funded by AstraZeneca. Gutierrez reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.