Impact of Peripheral Arterial Disease on Clinical Outcomes of Patients Undergoing Complex vs Non-Complex Percutaneous Coronary Intervention

Peripheral arterial disease (PAD) often predicts poor outcomes in patients undergoing percutaneous coronary intervention (PCI). Here we examine the impact of PAD in patients receiving complex PCI (CPCI) and non-complex PCI. Patients undergoing PCI at the Mount Sinai Hospital between 2012 and 2022 were stratified by the presence of CPCI and PAD. The primary outcome was major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, target vessel revascularization, or stroke within 1 year; secondary endpoints included bleeding events. An adjusted Cox proportional hazard method was used to evaluate risks of each outcome within each subgroup. Among 20,376 patients, 8,200 (40.2%) had CPCI and 1,959 (9.6%) had PAD. PAD patients were older and more likely to be female and have risk factors such as diabetes and smoking and were more commonly discharged with anticoagulants. 1-year risk of MACE was significantly higher for patients with PAD in both CPCI (19.6% vs. 14.4%, adj. hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.08-1.58, P= 0.006) and no-CPCI strata (13.9% vs. 9.2%, adj. HR 1.35, 95% CI 1.12-1.64, P = 0.002; P-interaction = 0.349). Bleeding events were also more frequent in PAD patients for CPCI (8.5% vs. 5.5%, adj. HR 1.40, 95% CI 1.07-1.84, P = .014) and no-CPCI (7.1% vs. 4.3%, adj. HR 1.52, 95% CI 1.18-1.96, P = 0.001; P-interaction = 0.608). In conclusion, presence of PAD is associated with a significantly increased risk of MACE and bleeding after PCI, regardless of procedural complexity.