Impact of peripheral arterial disease and cerebrovascular disease on outcomes in patients undergoing PCI

Background : Patients with peripheral arterial disease (PAD) or cerebrovascular disease (CeVD) are known to have worse outcomes when undergoing percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Methods : We conducted a retrospective cohort study to investigate the impact of PAD and CeVD, and their various presentation subtypes on the clinical outcomes in patients undergoing PCI. 21,978 patients undergoing PCI at the Mount Sinai Hospital between 2012 and 2022 were stratified by the presence of PAD and/or CeVD and their most common presentation subtypes. Results : Among the cohorts 1,613 (7.3%) patients had PAD, 1,874 (8.5%) had CeVD and 453 (2.1%) had both (polyvascular group) while the CAD only (control group) 18,038 (82.1%) had neither. 1-year risk of MACCE was significantly higher for patients with PAD, CeVD or both where patients presenting with PAD and prior intervention and CeVD with past cerebrovascular accident (CVA) with hemiparesis had the highest risk among the various subgroups. Patients with a history of CVA with/without hemiparesis had a higher risk of stroke post PCI. Bleeding events were more frequent in polyvascular and PAD patients, on subgroup analysis only the PAD with prior intervention subgroup was statistically significant. Conclusion : PAD, CeVD and polyvascular disease demonstrate a higher risk of MACCE in patients undergoing PCI. This increased risk of MACCE appears to be driven by those with prior intervention or CVA with hemiparesis. An increased risk of bleeding is seen in patients with PAD, polyvascular disease and PAD with prior intervention when stratified by subgroup.