# Prognostic Significance of Peripheral Artery Disease in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

## TL;DR

This study shows that peripheral artery disease significantly worsens outcomes in patients with heart attacks undergoing a common treatment and improves risk prediction models.

## Contribution

Demonstrates that PAD adds incremental prognostic value to the GRACE risk score in ACS patients undergoing PCI.

## Key findings

- PAD was associated with significantly higher rates of major adverse cardiovascular events and other outcomes.
- PAD independently predicted MACE occurrence after adjusting for confounding factors.
- Adding PAD to the GRACE score improved predictive performance for MACE.

## Abstract

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.

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.

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).

In ACS cases administered PCI, PAD
independently worsens clinical outcomes and adds incremental value to the GRACE
risk score.