RSNA: Peripheral and coronary arterial disease go hand-in-hand
One out of five patients with peripheral arterial disease (PAD) also has significant but silent coronary artery disease (CAD), according to the results of a randomized, controlled clinical trial presented at the annual meeting of the Radiological Society of North America (RSNA).
"PAD patients, including those experiencing no symptoms of heart disease, are known to be at high risk for cardiovascular events such as a heart attack or stroke," said Rozemarijn Vliegenthart Proenca, MD, PhD, radiology resident at the University Medical Center Groningen in the Netherlands. "The purpose of our clinical trial was to investigate whether noninvasive imaging of the heart and subsequent treatment of PAD patients result in a decrease in cardiac events compared to standard care."
In the clinical trial, 231 PAD patients from four participating hospitals in the Netherlands were divided into one of two groups: one in which 108 patients received standard care—consisting of lifestyle changes and medication—for their condition, and a second group in which 115 patients underwent cardiac imaging—CT and MRI—in addition to standard care.
Among the 115 patients who received cardiac imaging, CT revealed that 53, or 46 percent, had at least one significant coronary stenosis. Of those 53 patients, 22 had significant stenosis in the left main coronary artery or its equivalent, and were referred for treatment. Eight of those patients subsequently had bypass surgery, and three underwent coronary angiography with stent placement. The remaining patients were treated with medication.
Cardiac stress MRI was then performed on 76 patients. Results of the cardiac stress MRI exams identified two additional patients with signs of coronary artery disease, one of whom underwent angiography and stent placement.
In total, 24 (21 percent) of the 115 patients with PAD who underwent imaging had evidence of asymptomatic but severe coronary artery disease that required additional treatment.
"The results of our trial stress that PAD patients without a history of cardiac symptoms should undergo extensive cardiovascular risk factor management," Vliegenthart Proenca said.
"PAD patients, including those experiencing no symptoms of heart disease, are known to be at high risk for cardiovascular events such as a heart attack or stroke," said Rozemarijn Vliegenthart Proenca, MD, PhD, radiology resident at the University Medical Center Groningen in the Netherlands. "The purpose of our clinical trial was to investigate whether noninvasive imaging of the heart and subsequent treatment of PAD patients result in a decrease in cardiac events compared to standard care."
In the clinical trial, 231 PAD patients from four participating hospitals in the Netherlands were divided into one of two groups: one in which 108 patients received standard care—consisting of lifestyle changes and medication—for their condition, and a second group in which 115 patients underwent cardiac imaging—CT and MRI—in addition to standard care.
Among the 115 patients who received cardiac imaging, CT revealed that 53, or 46 percent, had at least one significant coronary stenosis. Of those 53 patients, 22 had significant stenosis in the left main coronary artery or its equivalent, and were referred for treatment. Eight of those patients subsequently had bypass surgery, and three underwent coronary angiography with stent placement. The remaining patients were treated with medication.
Cardiac stress MRI was then performed on 76 patients. Results of the cardiac stress MRI exams identified two additional patients with signs of coronary artery disease, one of whom underwent angiography and stent placement.
In total, 24 (21 percent) of the 115 patients with PAD who underwent imaging had evidence of asymptomatic but severe coronary artery disease that required additional treatment.
"The results of our trial stress that PAD patients without a history of cardiac symptoms should undergo extensive cardiovascular risk factor management," Vliegenthart Proenca said.