SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Austin J. Pourmoussa, MD
Research Fellow
Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
Financial relationships: Full list of relationships is listed on the CME information page.
Daniel Koerfer, MD
Research Associate
Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
Disclosure information not submitted.
Akash Nijhawan, n/a
Medical Student
Florida International University Herbert Wertheim College of Medicine
Disclosure information not submitted.
Anshul Saxena, n/a
Statistician
Miami Cardiac & Vascular Institute
Disclosure information not submitted.
Venkataraghavan Ramamoorthy, MD, PhD
Healthcare Data and Research Scientist
Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
Disclosure information not submitted.
Zhenwei Zhang, PhD, MS
Biostatistician
Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
Disclosure information not submitted.
Raul Herrera, MD
Director, Research and Outcomes
Miami Cardiac and Vascular Institute
Disclosure information not submitted.
Constantino Pena, MD
Clinical Associate Professor Radiology
Florida International Universirty and University of South Florida
Financial relationships: Full list of relationships is listed on the CME information page.
Brian Schiro, MD, FSIR, RPVI
Program Director, Interventional Radiology Independent Residency Program
Miami Vascular Specialists
Financial relationships: Full list of relationships is listed on the CME information page.
Jihad Mustapha, MD
Interventional Radiologist and Chief Executive Officer
Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Michigan
Disclosure information not submitted.
Barry T. Katzen, MD, FSIR
Founder and Chief Medical Executive
Miami Cardiac and Vascular Institute
Disclosure information not submitted.
Cardiovascular events impact the outcomes of patients with peripheral artery disease (PAD), especially those with severe comorbidities. This study presents in-hospital cardiovascular outcomes of PAD patients with varying stages of chronic kidney disease (CKD) in a large population from a real-world database.
Materials and Methods:
Premier Healthcare data from 8.5 million hospitalized patients from 2016 to 2021 was retrospectively analyzed regarding PAD, CKD, major adverse cardiovascular events (MACE) and cardiovascular risk factors. As a composite endpoint, MACE was combined with myocardial infarction (MI), major and minor stroke, cardiac arrest, and cardiovascular death.
Results:
The analysis included 874,788 patients with a diagnosis of PAD (55.6% male; mean age: 69.5 y), of which 106,956 (12.2%) were diagnosed with any level of CKD (CKD 1-5), while 767,832 (87.8%) patients did not have any diagnosis of CKD (CKD 0). Incidence of in-hospital MACE was two to three times higher in patients with PAD and concurrent CKD compared to patients with PAD and no CKD (CKD 0: 4.7%; CKD 1-2: 12.3%; CKD 3-4: 14.8%; CKD 5: 12.8%; p< 0.0001). Likewise, incidence of every single endpoint (MI, total stroke, cardiac arrest, and cardiovascular death) increased significantly in PAD patients with CKD compared to PAD patients without CKD (p< 0.0001). Presence of coronary artery disease, carotid artery disease, past MI, prior coronary artery bypass grafting and prior percutaneous transluminal coronary angioplasty, was significantly higher among PAD patients with CKD compared to PAD patients without CKD (p< 0.0001).
Conclusion:
PAD patients with CKD were found to have a two to three times higher incidence of in-hospital major adverse cardiovascular events compared to PAD patients without CKD, and cardiovascular events were found more frequently in patients with advanced CKD stages. Given these findings, the presence of CKD among PAD patients might be associated with higher healthcare costs and other adverse hospital outcomes. Early aggressive management of CKD may help mitigate risk of in-hospital MACE among patients with PAD. Further research is needed to better characterize outcomes and populations at risk.