Preferred Treatment and Expected Risk in Coronary Intervention Patients With Peripheral Arterial Disease: Cardiologists’ Views Versus Trials Data

TL;DR

Cardiologists overestimate the prevalence of peripheral arterial disease in PCI patients but correctly identify higher risks, though they disagree on optimal treatment.

Contribution

This study compares cardiologists' perceptions with trial data on PCI patients with peripheral arterial disease.

Findings

Cardiologists overestimated the current prevalence of PADs in PCI patients.

Estimated higher complication rates in PADs patients were confirmed by trial data for bleeding, MI, and cardiac death.

Disparate views among cardiologists on preferred coronary treatment for PADs patients were observed.

Abstract

In aging Western populations, there is an increase in the prevalence of both coronary artery disease and peripheral arterial disease (PADs). Treatment of patients who undergo percutaneous coronary intervention (PCI) and have concomitant PADs may pose a challenge, but preferences of cardiologists regarding treatment and their views on complication risks are unknown.

This work was a survey-based study comparing cardiologists’ views with patient-level data of PCI trials (BIO-RESORT and BIONYX).

The survey was completed by 47 of 208 (23%) invited cardiologists. A growing prevalence of PADs was observed in the trials and by 50% of the respondents. Cardiologists estimated that 22% of current PCI patients had PADs, whereas this rate was 7.3% among 6002 all-comer patients. In PADs patients, PCI procedural complication rates were estimated to be higher, which was not observed in either trial. The estimated higher 3-year rates of bleeding, myocardial infarction, and cardiac death in PCI patients with PADs were corroborated by corresponding trial data (P = 0.014, P = 0.005, and P < 0.001, respectively). Nevertheless, PADs affected the preferred treatment in many cardiologists, and cardiologists held disparate views on preferred coronary treatment.

Cardiologists correctly estimated the increase in PADs over time among PCI patients, but they overestimated the current prevalence. An increased risk of adverse clinical events after PCI was correctly recognized, and concomitant PADs often affected the preferred treatment. Notably, cardiologists held disparate views on optimal preferred coronary treatment, which may be attributed to the lack of reported data about this patient group. Thus, more clinical attention and research is warranted.

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