Influence of concomitant percutaneous transluminal angioplasty with percutaneous coronary intervention on cardiovascular and limb outcomes in patients with chronic stable lower extremity artery diseases

Abstract

Concomitant percutaneous transluminal angioplasty (PTA) at the time of percutaneous coronary intervention (PCI) is often performed because lower extremity artery disease (LEAD) often coincides with coronary artery disease. We investigated the impact of concomitant PTA on both cardiovascular and limb outcomes in the Korean National Health Insurance Service registry. Among 78,185 patients undergoing PCI, 6,563 patients with stable LEAD without limb ischemia were included. After 1:5 propensity score-matching was conducted, 279 patients in the PTA + PCI group and 1,385 patients in the PCI group were compared. Multivariate Cox proportional hazard models showed that the risk of all-cause death was higher in the PTA + PCI group than in the PCI group whereas the risks of myocardial infarction, repeat revascularization, stroke, cardiovascular death and bleeding event were not different between the 2 groups. In contrast, the risks of end-stage renal diseases and unfavorable limb outcomes were higher in the PTA + PCI group. Mediation analyses revealed that amputation and PTA after discharge significantly mediated the association between the concomitant PTA and all-cause death. Concomitant PTA was not associated with an increased risk of cardiovascular events but may increase the risk of all-cause death mediated by unfavorable renal and limb outcomes in patients with stable LEAD.