Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk

Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p> The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age &gt;18 years, and ACS within 30 days, or age &lt;55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> ABI &lt;0.8 was found in 10.5%, &lt;0.9 in 22.5%, &gt;1.3 in 4.8%, and &gt;1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI &lt;0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI &gt;27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI &lt;0.9 and ABI &lt;0.8, the six-month case-fatality rates were 2.5% ( p = 0.27) and 5.4% ( p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI &lt;0.8, and ACS. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk. </jats:p></jats:sec>