Outcomes of Percutaneous Coronary Intervention In Patients With Peripheral Artery Disease Presenting with Acute Myocardial Infarction

Background
Peripheral artery disease (PAD) often coexists in patients with coronary artery disease (CAD) and is associated with adverse cardiovascular outcomes. Percutaneous coronary intervention (PCI) in patients with PAD is associated with higher mortality and procedural complications. However, the impact of PAD in acute myocardial infarction (MI) patients undergoing PCI remains unknown.

Methods
We analyzed the Nationwide Inpatient Sample (NIS) database to compare the age adjusted inpatient morality rate for acute MI patients with known PAD undergoing PCI to those without established PAD between 2000 and 2011. Specific ICD-9 CM codes were used to identify these patients.

Results
A total of 1,155,018 acute MI patients underwent PCI during the study period of which 69,643 patients (6%) had PAD. Patients with PAD were older (72.8±10.2 years) and mostly (55%) were male. The age adjusted inpatient mortality rate following PCI for acute MI was significantly higher in PAD group compared to the no PAD group (123.02±15.94 vs 117.99±4.5 per 100,000, P<0.0001). When the analysis was restricted to severe PAD (defined as patients with rest pain or tissue loss) the mean age adjusted inpatient mortality rate following PCI was significantly higher in the severe PAD group compared to no severe PAD group (164.14±71.86 vs 117.95±4.76 per 100,000, P<0.0001).

Conclusions
Peripheral artery disease is associated with higher age adjusted inpatient mortality rates in acute MI patients undergoing PCI. Presence of severe PAD confers an even higher inpatient mortality risk in these patients.