Prognostic importance of lower extremity arterial disease in patients undergoing coronary revascularization in the Bypass Angioplasty Revascularization Investigation (BARI)

OBJECTIVES The purpose of this study was to evaluate the prevalence and pro gnostic importance of lower extremity arterial disease (LEAD) in patients w ith multivessel coronary artery disease. BACKGROUND The presence of clinically evident LEAD increases the risk of de ath in patients with known coronary artery disease. Because studies have la cked noninvasive measures of subclinical LEAD, the true prognostic importan ce of lower extremity atherosclerosis in this population has probably been underestimated. METHODS Ankle blood pressures were measured in 405 consecutive patients wit h angiographically documented multivessel coronary disease from seven Bypas s Angioplasty Revascularization Investigation (BARI) sites and a parallel s tudy site within 3 years of enrollment. Lower extremity arterial disease wa s defined as an ankle/arm systolic blood pressure ratio of 0.90 or less. RESULTS Among patients studied, 69 (17%) had LEAD. These patients were more likely to be current smokers, treated for diabetes, older and present with unstable angina compared with patients without LEAD. Among patients who un derwent coronary arterial bypass grafting, major complications occurred in 2.8% of those without LEAD compared with 20.7% of those with LEAD (p = 0.00 2). Five-year mortality rates were similar for symptomatic LEAD (14%) and a symptomatic LEAD (14%). Patients without LEAD had a 3% mortality. After adj usting for baseline differences, the relative risk of death was 4.9 times g reater for patients with LEAD compared with those without (95% confidence i nterval [CI]: 1.8, 13.4, p < 0.01). CONCLUSIONS Patients with LEAD have a significantly higher risk of death th an patients without LEAD, regardless of the presence of symptoms. An abnorm al ankle/arm index is a strong predictor of mortality and can be used to fu rther stratify risk among patients with multivessel coronary artery disease . (J Am Coll Cardiol 1999;34:716-21) (C) 1999 by the American College of Ca rdiology.