BACKGROUND The cardiovascular (CV) risk of polyvascular disease in the background of peripheral artery disease (PAD) has not been previously described. METHODS EUCLID (NCT01732822) evaluated the effect of ticagrelor versus clopidogrel, in preventing CV events in 13,885 PAD patients. The primary efficacy (CV death, MI, and ischemic stroke) and primary safety (TIMI major bleeding) end points were compared between patients with PAD alone, PAD + cerebrovascular disease (CVD), PAD + coronary artery disease (CAD), and PAD + CVD + CAD. An adjusted Cox proportional hazards model was used to determine the risk over time of the primary end points. RESULTS At randomization, 7804 (56%) patients had PAD alone; 2639 (19%) had PAD + CAD; 2049 (15%) had PAD + CVD; and 1393 (10%) had PAD + CVD + CAD. The rates (events per 100 patient-years of follow-up) for the primary end point were as follows: PAD alone (3.4%), PAD + CVD (4.8%), PAD + CAD (5.7%), and PAD + CVD + CAD (8.1%). Compared with patients with isolated PAD, the adjusted hazard ratios for the primary endpoint in patients with PAD + CVD, PAD + CAD, and PAD + CVD + CAD were 1.34 (95% CI 1.15-1.57, p=0.0002), 1.65 (95% CI 1.43-1.91, p<0.0001), and 1.99 (95% CI 1.69- 2.34, p<0.0001), respectively. Compared with isolated PAD, polyvascular disease was not associated with a significant increased risk of major bleeding. CONCLUSION In EUCLID, a trial of patients with PAD, 44% of patients had polyvascular disease. With a background of PAD, the risk of CV events increases with multiple vascular bed involvement, greatest in patients with concomitant CAD (PAD + CAD or PAD + CVD + CAD). (Figure Presented).
Gutierrez, A., Mulder, H., Jones, S., Rockhold, F., Berger, J., Blomster, J., … Patel, M. (2017). TCT-92 Polyvascular Disease and Risk of Major Cardiovascular Events in Peripheral Artery Disease—Insights from EUCLID. Journal of the American College of Cardiology, 70(18), B40. https://doi.org/10.1016/j.jacc.2017.09.148