Involvement of atherosclerosis in extracardiac vascular territories may identify coronary artery disease (CAD) patients at higher risk for adverse events. We investigated the long-term prognostic implications of polyvascular disease in patients with CAD, and further analyzed lipid goal attainment and its relation to patient outcomes.
The study was a retrospective analysis of 10,297 patients undergoing coronary revascularization, categorized as having CAD alone (83.1%) or with multisite artery disease (MSAD) (16.9%) including cerebrovascular disease (CBVD) and/or peripheral artery disease (PAD). Incidence rates and hazard ratios (HR) for MACE (myocardial infarction, ischemic stroke or all-cause death) according to vascular territories involved, and in relation to most-recent lipid levels attained, were analyzed.
Patients with MSAD were older with higher burden of comorbidities. The rate of MACE (myocardial infarction, ischemic stroke or all-cause death) and its individual components increased with the number of affected vascular beds. Adjusted HR (95% confidence interval) for MACE was 1.41 (1.24-1.59) in patients with CAD and CBVD, 1.46 (1.33-1.62) in CAD and PAD, and 1.69 (1.49-1.92) in those with CAD and CBVD and PAD, compared to CAD alone. Most-recent low-density lipoprotein cholesterol (LDL-C) levels <55mg/dL and <70mg/dL were attained by 21.8% and 44.6% of patients with CAD alone, in comparison to 22.7% and 43.3% in MSAD.
Compared to patients with most-recent LDL-C>100mg/dL, attaining LDL-C<70mg/dL had an adjusted HR for MACE of 0.52 (0.47-0.57) in CAD only patients and 0.66 (0.57-0.78) in MSAD patients. In conclusion, the presence of CBVD and/or PAD in patients with CAD is associated with higher burden of comorbidities and progressive increase in long-term MACE.
More than half of CAD patients with or without MSAD do not achieve lipid goals, which are associated with a significantly lower risk for adverse events.