CORONARY-ARTERY DISEASE IS HIGHLY PREVALENT AMONG PATIENTS WITH PREMATURE PERIPHERAL VASCULAR-DISEASE

Purpose: This study was designed to document the prevalence of coronar y artery disease (CAD) and associated cardiac complications among pati ents with symptoms of premature peripheral vascular disease. Methods: We studied the peripheral and coronary arterial circulations of 59 con secutive male military veterans diagnosed with premature peripheral va scular disease (age of onset less than or equal to 45 years) affecting the lower extremity. Patients who had not previously undergone corona ry angiography underwent exercise stress testing. Patients unable to p erform exercise testing and those with abnormal exercise test results underwent coronary angiography. Results: There was no evidence of CAD in 16 patients (29%) on the basis of normal exercise test results (n = 12) or normal coronary angiography results (n = 4). Forty-three patie nts (71%) had significant (greater than or equal to 50% lesion) CAD by coronary catheterization. Cardiac complications were frequent among t he 43 patients. Eleven (65%) of the 17 patients with single-vessel CAD had previously documented myocardial infarctions, as did three (75%) of the four patients with two-vessel CAD and 18 (82%) of the 22 patien ts with three vessel or greater CAD. Three (18%) patients with one-ves sel CAD had undergone coronary artery bypass grafting or percutaneous transluminal coronary angioplasty for symptoms, as had one patient (25 %) with two-vessel CAD and 19 patients (86%) with three-vessel or grea ter CAD. Five patients died during the study period, four of myocardia l infarction and one of stroke. Conclusions: Premature peripheral athe rosclerosis is associated with a high prevalence of CAD. Detection of CAD is important in this group, because cardiac complications are freq uent.