The Occurrence of Peripheral Artery Disease in Acute Coronary Syndrome Presenting to ICCU

Peripheral artery disease (PAD) is associated with worse clinical outcome in patients with stable CAD. Accordingly, recent guidelines have advocated the evaluation of PAD in CAD patients, including the calculation of Ankle-Brachial Index (ABI) in asymptomatic CAD patients. Only scarce data exists regarding the significance of ABI in patients presents with acute coronary artery syndrome (ACS).

Aim:

To determine the occurrence of PAD and to characterize ACS patients with PAD using routine ABI screening.

Methods:

We conducted ABI measurements in 209 consecutive ACS patients admitted to our ICCU. Baseline characteristic as well as in-hospital outcomes were evaluated. Outcomes were compared for patients with and without PAD.

Results:

A total 209 ACS patients (Figure) were hospitalized during the period of 06/2019-11/2019. The mean age was 64±12, 23% were female. A total of 36 (17.2%) patients had PAD, which was diagnosed based on clinical PAD (intermittent claudication and\or peripheral intervention) in 5 (14%) and on the presence of pathologic ABI (<0.9) in 31 (86%) patients. On the average PAD as compared to non-PAD patients had lower ABI (0.8±0.17 vs. 1.2±0.13,p<0.0001). PAD patients were older (68±12 vs. 63±11,p=0.02) and were more likely to have diabetes (61% vs. 32%, p<0.001). PAD patients had also higher incidence of a prior CVA (17% vs. 5.7%,p=0.02) and CHF (11% vs. 1.7%, p=0.004). Patients with PAD vs. non-PAD had equally high incidence of coronary reperfusion (81% vs. 89%,p=0.4), and were more likely to undergo CABG (3.3% vs. 0%, p=0.03). Despite the increased in co-morbidities the in-hospital course was relatively similar in PAD and non-PAD patients

Conclusion: The presences of PAD in ACS patients is relatively high and confirms higher co-morbidity, but with no increased in in-hospital mortality or complications. Screening for PAD during the course of acute hospitalization might provide a point of risk classification for further interventions.