Welten GMJM et al. (2008) Long-term prognosis of patients with peripheral arterial disease: a comparison in patients with coronary artery disease. J Am Coll Cardiol 51: 1588–1596

Aggressive treatment of atherosclerotic risk factors is recommended for patients with peripheral arterial disease (PAD) who require vascular surgery, yet the survival and treatment of these patients after surgery is unknown. Welten et al. conducted an observational study to determine the long-term outcomes of patients with PAD who undergo open vascular surgery.

This study involved 2,730 patients with PAD who underwent major vascular surgery at a medical center in Rotterdam, The Netherlands, during the period January 1993 to June 2006. These patients were propensity matched to patients with coronary artery disease (CAD) who underwent coronary angioplasty at the same center.

Patients with PAD had a significantly higher risk of long-term all-cause and cardiac mortality than those with CAD (unadjusted hazard ratio 2.4, 95% CI 2.18–2.65; mean follow up 6.37 ± 4.08 years and 9.17 ± 4.14 years for patients with PAD and CAD, respectively). For patients with PAD, the leading cause of death was cerebrocardiovascular events, in both the short term (i.e. 30 days after surgery; 76%) and long term (46%), yet patients with PAD received significantly fewer cardiac medications—such as statins, β-blockers, angiotensin-converting-enzyme inhibitors, aspirin and nitrates—than did patients with CAD (P <0.001 for all cardiac medications).

The authors conclude that outcome after surgery is worse in patients with PAD than in those with CAD, and they attribute the poor outcome in patients with PAD to the undertreatment of these individuals.