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Differences in coronary plaque characteristics between patients with and those without peripheral arterial disease

Bryniarski, Krzysztof L.a; Yamamoto, Erikaa; Takumi, Higumaa; Xing, Leia; Zanchin, Thomasa; Sugiyama, Tomoyoa; Lee, Hangb; Jang, Ik-Kyunga,c

doi: 10.1097/MCA.0000000000000531
Original Research
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Introduction Cardiovascular mortality of patients with combined peripheral arterial disease (PAD) and coronary artery disease (CAD) is twice as high as that in those with either disease alone. It is known that patients with PAD undergoing percutaneous coronary intervention have a higher incidence of adverse cardiac events such as myocardial infarction or target vessel revascularization.

Objective In this study, we compared the detailed characteristics of culprit and nonculprit plaques between patients with and those without PAD using optical coherence tomography.

Patients and methods We performed propensity score matching using the following variables: (i) age; (ii) sex; (iii) clinical presentation; (iv) diabetes mellitus; (v) hyperlipidemia; (vi) smoking; (vii) hypertension; (viii) BMI; and (ix) coronary lesion location. Finally, we matched 34 culprit lesions and 30 nonculprit lesions in patients with PAD to 68 culprit lesions and 60 nonculprit lesions in patients without PAD (1 : 2 ratio).

Results In culprit lesions, PAD patients when compared with those without PAD had a higher prevalence of lipid-rich plaque (73.5 vs. 51.5%; P=0.033), higher lipid index (1744±1110 vs. 1246±656; P=0.043), calcification (79.4 vs. 58.8%; P=0.039), macrophage accumulation (70.6 vs. 48.5%; P=0.034), and cholesterol crystals (32.4 vs. 10.3%; P=0.006). In nonculprit lesions, PAD patients had a higher prevalence of calcification (76.7 vs. 55.0%; P=0.046), macrophage accumulation (63.3 vs. 38.3%; P=0.025), and cholesterol crystals (36.7 vs. 16.7%; P=0.034).

Conclusion Our study suggests greater coronary plaque vulnerability in both culprit and nonculprit lesions in patients with PAD. This observation underscores the need for more aggressive risk management in patients with combined PAD and coronary artery disease.

Supplemental Digital Content is available in the text.

aCardiology Division

bBiostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

cDivision of Cardiology, Kyung Hee University Hospital, Seoul, Republic of Korea

Correspondence to Ik-Kyung Jang, MD, PhD, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA Tel: +1 617 726 9226; fax: +1 617 726 7416; e-mail: ijang@mgh.harvard.edu

Received May 2, 2017

Received in revised form June 12, 2017

Accepted June 14, 2017

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