IMR Press / RCM / Volume 24 / Issue 11 / DOI: 10.31083/j.rcm2411332
Open Access Original Research
Prognostic Significance of Peripheral Artery Disease in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
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1 Beijing Institute of Heart Lung and Blood Vessel Disease, 100029 Beijing, China
2 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
*Correspondence: (Xiaoteng Ma); (Yujie Zhou)
These authors contributed equally.
Rev. Cardiovasc. Med. 2023, 24(11), 332;
Submitted: 9 February 2023 | Revised: 5 April 2023 | Accepted: 12 April 2023 | Published: 24 November 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Peripheral artery disease (PAD) elevates the risk of adverse outcomes. The current work aimed to evaluate the influence of PAD in acute coronary syndrome (ACS) cases administered percutaneous coronary intervention (PCI), and to determine whether PAD adds incremental prognostic value to the global registry of acute coronary events (GRACE) scale. Methods: To retrospectively analyze a single-center, prospective cohort trial, we consecutively included ACS cases administered PCI. Individuals with and without PAD were comparatively examined for clinical outcomes. The primary endpoint was major adverse cardiovascular events (MACEs), a compound item encompassing all-cause death, myocardial infarction (MI), stroke and repeat revascularization. The added value of PAD based on a reference model was examined. Results: PAD was detected in 179 (10.4%) of the 1,770 included patients. The incidence rates of MACEs (40.3% vs. 17.9%), all-cause death (11.2% vs. 1.6%), cardiovascular death (8.9% vs. 1.4%), MI (8.4% vs. 2.2%) and repeat revascularization (30.2% vs. 15.2%) were all markedly elevated in PAD cases in comparison with the non-PAD group (p < 0.001). After adjusting for other confounding variates, PAD independently predicted MACE occurrence (hazard ratio = 1.735, 95% confidence interval: 1.281–2.351). Addition of PAD resulted in remarkably increased predictive performance for MACE compared to the baseline GRACE score (Harrell’s C-statistic: 0.610 vs. 0.587, p < 0.001; net reclassification improvement: 0.134, p < 0.001; integrated discrimination improvement: 0.035, p < 0.001). Conclusions: In ACS cases administered PCI, PAD independently worsens clinical outcomes and adds incremental value to the GRACE risk score.

peripheral artery disease
acute coronary syndrome
percutaneous coronary intervention
cardiovascular outcomes
2022YFC3602500/National Key Research and Development Program of China
82200405/Youth Fund Project of National Natural Science Foundation of China
Fig. 1.
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