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patients with peripheral arterial disease have an increased incidence of all- cause mortality and of mortality from coronary artery disease [ 16 ] . these studies did not include the incidence of pad revascularization [ 16 ] .
patients with pad also have a high prevalence of moderate or severe chronic kidney disease with an estimated glomerular filtration rate < 60 ml / min/1.73 m. the present study investigated the incidence of all - cause mortality , new stroke / transient ischemic attack , new myocardial infarction , new coronary revascularization , new carotid endarterectomy , new pad revascularization , and of at least one of these 6 outcomes in patients with and without pad followed in a vascular surgery clinic .
we investigated in 503 consecutive patients ( 414 with pad and 89 without pad ) followed in an academic peripheral vascular disease outpatient clinic the incidence at long - term follow - up of all - cause mortality , new stroke / transient ischemic attack , new myocardial infarction , new coronary revascularization , new carotid endarterectomy , new pad revascularization , and of at least one of these 6 outcomes .
pad was diagnosed if the ankle - brachial index was < 0.90 or 1.40 , if the patient had prior pad revascularization , if the patient had carotid arterial disease , or if the patient had an abdominal aortic aneurysm .
all patients with no pad had a normal bilateral ankle - brachial index and were referred to the vascular disease clinic because of lower extremity symptoms thought to be possible pad .
student s t - test was used to analyze continuous variables and fisher s exact test and chi - square analysis for dichotomous variables .
stepwise cox regression analysis was performed for the time to death or new stroke / transient ischemic attack or new myocardial infarction or new coronary revascularization or new carotid endarterectomy or new pad revascularization .
this study was approved by the new york medical college institutional review board and by the institutional review board of westchester medical center .
table 1 shows the baseline characteristics in 414 patients with pad and in 89 patients without pad and lists levels of statistical significance .
table 2 shows the incidences of all - cause mortality , new stroke / transient ischemic attack , new myocardial infarction , new coronary revascularization , new carotid endarterectomy , new pad revascularization , and of at least one of these 6 outcomes in patients with and without pad followed in a vascular surgery clinic .
table 3 shows the stepwise cox regression analysis for the time to at least one of the 6 outcome variables using the baseline variables listed in table 1 , pad , and carotid arterial disease .
table 4 shows the stepwise cox regression analysis for the time to death using the baseline variables listed in table 1 , pad , and carotid arterial disease .
patients with peripheral arterial disease have an increased incidence of all - cause mortality and of mortality from coronary artery disease [ 16 ] .
these studies did not include the incidence of pad revascularization or carotid endarterectomy [ 16 ] .
patients with pad also have a high prevalence of moderate or severe chronic kidney disease with an estimated glomerular filtration rate < 60 ml / min/1.73 m. the present study performed in 503 patients followed in a vascular surgery clinic showed that the patients with pad were older and had a significantly higher prevalence of hypertension , of an abdominal aortic aneurysm , and of a low estimated glomerular filtration rate and a significantly lower incidence of obesity than the patients without pad .
the follow - up was significantly higher in patients with no pad ( 48 months ) than in patients with pad ( 33 months ) . at follow - up , compared to patients with no pad , patients with pad had a significant increase in all - cause mortality ( 27% vs. 11% , p=0.002 ) , an insignificant increase in new stroke / transient ischemic attack ( 5% vs. 1% ) , no significant difference in new myocardial infarction or new coronary revascularization , a significant increase in new pad revascularization ( 34% vs. 1% , p<0.0001 ) , a significant increase in new carotid endarterectomy ( 8% vs. 0% , p = 0.005 ) , and a significant increase in at least one of these 6 outcomes ( 63% vs. 24% , p<0.0001 ) .
our study also showed that men were 39% significantly more likely to develop at least one of these 6 outcomes .
patients with a lower estimated glomerular filtration rate were significantly more likely to develop at least one of these 6 outcomes .
patients with pad were 3.5 times significantly more likely to develop at least one of these 6 outcomes .
in addition , our study also showed that patients who were older and who had a lower estimated glomerular filtration rate were significantly more likely to die .
these data support that patients with pad must be treated with risk factor modification to try to reduce these unfavorable outcomes .
summarybackgroundto investigate the incidence of death and of new cardiovascular events at long - term follow - up of patients with and without pad seen in a vascular surgery clinic.material/methodswe investigated the incidence of death , new stroke / transient ischemic attack , new myocardial infarction , new coronary revascularization , new carotid endarterectomy , new peripheral arterial disease ( pad ) revascularization , or at least one of the above outcomes at long - term follow - up of patients with and without pad followed in a vascular surgery clinic.resultsat least one of the above outcomes occurred in 259 of 414 patients ( 63% ) with pad at 33-month follow - up and in 21 of 89 patients ( 24% ) without pad at 48-month follow - up ( p<0.0001 ) . 
 death occurred in 112 of 414 patients ( 27% ) with pad and in 10 of 89 patients ( 11% ) without pad ( p=0.002 ) . 
 stepwise cox regression analysis for the time to at least one of the 6 outcomes showed that significant independent risk factors were men ( hazard ratio = 1.394 ; 95% ci , 1.0721.813 ; p=0.013 ) , estimated glomerular filtration rate ( hazard ratio = 0.992 ; 95% ci , 0.9870.997 ; p=0.003 ) , and pad ( hazard ratio = 3.520 ; 95% ci , 2.1965.641 ; p<0.0001 ) . 
 stepwise cox regression analysis for the time to death showed that significant independent risk factors were age ( hazard ratio = 1.024 ; 95% ci , 1.0001.049 ; p=0.048 ) , estimated glomerular filtration rate ( hazard ratio = 0.985 ; 95% ci , 0.9740.996 ; p=0.007 ) , and pad ( hazard ratio = 2.157 ; 95% ci , 1.1184.160 ; p=0.022).conclusionspatients with pad have a significantly higher incidence of cardiovascular outcomes , especially death , new pad revascularization , and new carotid endarterectomy , than patients without pad followed in a vascular surgery clinic .