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The following is a summary of “Impact of Peripheral Arterial Disease on Clinical Outcomes of Patients Undergoing Complex vs Non-Complex Percutaneous Coronary Intervention,” published in the March 2025 issue of The American Journal of Cardiology by Gao et al. 

Peripheral arterial disease (PAD) has long been recognized as a marker of systemic atherosclerosis and adverse cardiovascular outcomes, yet its prognostic significance in the context of percutaneous coronary intervention (PCI), particularly when stratified by procedural complexity, remains underexplored. This study aimed to evaluate the impact of PAD on clinical outcomes in patients undergoing either complex PCI (CPCI) or non-complex PCI at Mount Sinai Hospital over 10 years from 2012 to 2022. A total of 20,376 patients were included in this retrospective cohort analysis, with 8,200 (40.2%) classified as having undergone CPCI and 1,959 (9.6%) identified with coexisting PAD. 

Baseline characteristics revealed that patients with PAD were generally older, more frequently female, and had a higher prevalence of comorbidities including diabetes mellitus and active smoking. These patients were also more likely to be discharged on anticoagulation therapy, reflecting their higher thrombotic risk profile. The primary outcome assessed was the incidence of major adverse cardiovascular events (MACE)—a composite endpoint encompassing all-cause mortality, myocardial infarction, target vessel revascularization, and stroke—within one-year post-PCI. Secondary endpoints included bleeding complications. Using an adjusted Cox proportional hazards model, PAD was found to be a significant and independent predictor of increased MACE risk in both CPCI (19.6% vs. 14.4%, adjusted [HR] 1.31; 95% [CI] 1.08–1.58; P = 0.006) and non-CPCI (13.9% vs. 9.2%, adjusted HR 1.35; 95% CI 1.12–1.64; P = 0.002) subgroups, with no significant interaction between PAD status and procedural complexity (P-interaction = 0.349). 

Similarly, bleeding events were notably more frequent among patients with PAD regardless of PCI complexity. In the CPCI cohort, bleeding occurred in 8.5% of patients with PAD versus 5.5% without PAD (adjusted HR 1.40; 95% CI 1.07–1.84; P = 0.014), while in the non-CPCI group, rates were 7.1% versus 4.3% (adjusted HR 1.52; 95% CI 1.18–1.96; P = 0.001), again with no significant interaction by procedural type (P-interaction = 0.608). These findings underscore the substantial and consistent risk conferred by PAD in patients undergoing PCI, independent of the procedural complexity. The increased incidence of both ischemic and bleeding events in this high-risk population highlights the need for careful risk stratification, individualized therapeutic planning, and post-procedural surveillance. In conclusion, PAD serves as a powerful prognostic indicator associated with worse clinical outcomes following PCI, reinforcing its relevance in procedural planning and long-term management strategies across the PCI spectrum.

Source: ajconline.org/article/S0002-9149(25)00213-9/abstract