Ischaemic heart disease and peripheral arterial disease: Routinely coronary angiography as strategy to reduce global risk

Atherosclerotic change in extracoronary arteries (i.e. thoracic and abdominal aorta, and carotid and femoral arteries) are associated with the extent of coronary atherosclerosis. The incidence of coronary artery disease and the clinical outcome of 163 consecutive patients affected with peripheral arterial disease (PAD), all subjected to coronary angiography, were determined in a prospective observational study. Forty patients (24.5%) were found to have significant coronary atherosclerotic disease (CAD) with a normal exercise ECG test and/or dipyridamole-thallium scintigraphy. The overall rate of myocardial revascularization observed was 56.4%, with a perioperative mortality rate (30 days) of 3.6%. Wide consensus exists on considering PAD as a CAD equivalent: patients are currently under-treated with regard to atherosclerotic risk factor modification and surgical treatment. Cardiovascular physicians should assume a more proactive clinical role in encouraging a correct therapeutic approach to the treatment of arterial diseases affecting multiple vascular beds, including extensive coronary angiography. © 2007 Pharma Project Group srl