Prevalence of Coronary Heart Disease in Patients With Aortic Aneurysm and/or Peripheral Artery Disease

Hirose, Kenichi; Chikamori, Taishiro; Hida, Satoshi; Tanaka, Hirokazu; Igarashi, Yuko; Watanabe, Yoshiko; Koizumi, Nobusato; Kawaguchi, Satoshi; Obitsu, Yukio; Shigematsu, Hiroshi; Yamashina, Akira

doi:10.1016/j.amjcard.2009.01.033

« Previous Next »American Journal of Cardiology
Volume 103, Issue 9 , Pages 1215-1220, 1 May 2009

Prevalence of Coronary Heart Disease in Patients With Aortic Aneurysm and/or Peripheral Artery Disease

Kenichi Hirose, MD
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
Taishiro Chikamori, MD
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
- Corresponding author: Tel: +81-3-3342-6111; fax: +81-3-5381-6652
Satoshi Hida, MD
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
Hirokazu Tanaka, MD
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
Yuko Igarashi, MD
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
Yoshiko Watanabe, MD
- Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
Nobusato Koizumi, MD
- Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
Satoshi Kawaguchi, MD
- Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
Yukio Obitsu, MD
- Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
Hiroshi Shigematsu, MD
- Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
Akira Yamashina, MD
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan

Received 15 October 2008; received in revised form 9 January 2009; accepted 9 January 2009.

Although the presence of coronary heart disease (CHD) was the major determinant of perioperative mortality and long-term prognosis in patients with aortic aneurysm (AA) and peripheral artery disease (PAD), the prevalence and severity of CHD in patients with individual vascular diseases was unknown. Adenosine triphosphate–loading myocardial single-photon emission computed tomography therefore was performed in 788 patients with vascular diseases of the aorta and peripheral arteries, with AA in 500, PAD localized in the lower-limb arteries in 183, and combined AA and PAD in 105. Patients with known CHD, such as those with previous myocardial infarction or revascularization procedures, were excluded. Myocardial single-photon emission computed tomography was analyzed using a 20-segment model, and summed stress scores and summed difference scores were calculated. Stress-induced myocardial ischemia was defined as a summed difference score ≥2. The presence of myocardial ischemia was highest in patients with combined PAD and AA (73%), followed by PAD (55%; p = 0.005), and the lowest in patients with AA (37%; p <0.0001). Summed stress score was also the highest in patients with combined PAD and AA (11.6 ± 9.9), followed by PAD (7.8 ± 8.8; p <0.0001), and the lowest in patients with AA (4.0 ± 6.2; p <0.0001 for both). Similarly, summed difference score was the highest in patients with combined PAD and AA (6.4 ± 6.1), followed by PAD (4.4 ± 5.7; p = 0.001) and AA (2.3 ± 4.0; p <0.0001 for both). In conclusion, the prevalence of CHD in patients with PAD was >50%, and although myocardial ischemia was observed in only ⅓ of patients with AA, its prevalence not only doubled, but also indicated extensive myocardial ischemia when combined with PAD. Thus, cardiac evaluation was particularly important in patients with combined AA and PAD.