Peripheral Arterial Disease in Coronary Artery Bypass Graft Candidates: Prevalence, Risk Factors and Functional Mobility
Keywords:prevalence, peripheral arterial disease (PAD), coronary artery bypass, ankle brachial index (ABI), mobility, quality of life
Objectives: To determine the prevalence of peripheral arterial disease (PAD) among coronary artery bypass graft (CABG) candidates during the preoperative period of their surgical admission using the ankle brachial index (ABI) screening method and to evaluate risk factors, quality of life, and functional mobility.
Study design: Cross-sectional study.
Setting: Siriraj Hospital.
Subjects: Coronary artery bypass candidates.
Methods: Ankle brachial index (ABI) ≤ 0.9 was used to diagnose PAD. The four-meter walk test (4MWT) was used to evaluate functional mobility and the 36-Item Short Form Survey (SF-36) was used to evaluate quality of life.
Results: Of 192 candidates, 143 (74.5%) were male and 49 (25.5%) were female. Mean age was 64 years (SD 10). The prevalence of PAD identified by ABI screening was 12.5%. However, only 4.2% had a history of PAD. Age was the only risk factor significantly correlated with coexisting PAD in the CABG candidates. PAD risk was higher in patients of advanced age. There were no statistically significant differences between the PAD and non-PAD groups in calf pain or claudication symptoms, congestive heart failure, foot ulcers, end-stage renal disease (ESRD) or osteoarthritis of knee (OA knee). However, left ven-tricular ejection fraction (LVEF) was lower in the PAD group (mean 46.0, SD 20.9) than the non-PAD group (mean 55.95, SD 17.19) (p = 0.031). Time needed to complete the 4MWT was significantly higher in the PAD group (mean 6.6, SD 2.6 seconds) than non-PAD group (mean 4.9, SD 1.8 seconds) (p = 0.01). SF-36 revealed that the PAD group had a lower quality of life in the physical domain (p = 0.007).
Conclusions: PAD was identified in 12.5% of the CABG candidates. However, most cases were unrecognized. The PAD group had lower LVEF, functional mobility, physical health domain of quality of life than the non-PAD group.
Keywords: prevalence, peripheral arterial disease (PAD), coronary artery bypass, ankle brachial index (ABI), mobility, quality of life
Dieter RS, Chu WW, Pacanowski JP, Jr., McBride PE, Tanke TE. The significance of lower extremity peripheral arterial disease. Clin Cardiol. 2002;25:3-10.
Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317-24.
Tunstall-Pedoe H. Preventing chronic diseases. A vital investment: WHO global report. Geneva: World Health Organization, 2005.
Rukumnuaykit P. Mortality and causes of death in Thailand: evidence from the survey of population change and death registration. 2007;21:67-84.
Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001;344:1608-21.
Sritara P, Sritara C, Woodward M, Wangsuphachart S, Barzi F, Hengprasith B, et al. Prevalence and risk factors of peripheral arterial disease in a selected Thai population. Angiology. 2007;58: 572-8.
Mehlsen J, Wiinberg N, Joergensen BS, Schultz-Larsen P. High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event. Blood Press. 2010;19:308-12.
Dieter RS, Tomasson J, Gudjonsson T, Brown RL, Vitcenda M, Einerson J, et al. Lower extremity peripheral arterial disease in hospitalized patients with coronary artery disease. Vasc Med. 2003;8:233-6.
Jeger RV, Rickenbacher P, Pfisterer ME, Hoffmann A. Outpatient rehabilitation in patients with coronary artery and peripheral arterial occlusive disease. Arch Phys Med Rehabil. 2008;89:618-21.
Chu D, Bakaeen FG, Wang XL, Dao TK, LeMaire SA, Coselli JS, et al. The impact of peripheral vascular disease on long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg. 2008;86:1175-80.
van Straten AH, Firanescu C, Soliman Hamad MA, Tan ME, ter Woorst JF, Martens EJ, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. Ann Thorac Surg. 2010; 89:414-20.
Leng GC, Fowkes FG. The Edinburgh claudication questionnaire: an improved version of the WHO/Rose questionnaire for use in epidemiological surveys. J Clin Epidemiol. 1992;45:1101-9.
Krittayaphong R, Bhuripanyo K, Raungratanaamporn O, Chotinaiwatarakul C, Chaowalit N, Punlee K, et al. Reliability of Thai version of SF-36 questionnaire for the evaluation of quality of life in cardiac patients. J Med Assoc Thai. 2000;83 Suppl 2:S130-6.
Kim EK, Song PS, Yang JH, Song YB, Hahn JY, Choi JH, et al. Peripheral artery disease in Korean patients undergoing percutaneous coronary intervention: prevalence and association with coronary artery disease severity. J Korean Med Sci. 2013;28:87-92.
Alzamora MT, Fores R, Baena-Diez JM, Pera G, Toran P, Sorribes M, et al. The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010;10:38. doi: 10.1186//471-2458-38
Brevetti G, Oliva G, Silvestro A, Scopacasa F, Chiariello M. Prevalence, risk factors and cardiovascular comorbidity of symptomatic peripheral arterial disease in Italy. Atherosclerosis. 2004;175:131-8.
Jessadapattarakun S, Chadchavalpanichaya N. The prevalence of asymptomatic peripheral arterial disease in diabetic patients at Siriraj Hospital. J Thai Rehabil Med. 2016;26:54-60.
Agarwal AK, Singh M, Arya V, Garg U, Singh VP, Jain V. Prevalence of peripheral arterial disease in type 2 diabetes mellitus and its correlation with coronary artery disease and its risk factors. J Assoc Physicians India. 2012;60:28-32.
Boylan L, Nesbitt C, Wilson L, Allen J, Sims A, Guri I, et al. Reliability of the Edinburgh claudication questionnaire for identifying symptomatic PAD in general practice. Angiology. 2021;72:474-9.
Pita-Fernandez S, Modrono-Freire MJ, Pertega-Diaz S, Herrera-Diaz L, Seoane-Pillado T, Paz-Solis A, et al. Validity of the Edinburgh claudication questionnaire for diagnosis of peripheral artery disease in patients with type 2 diabetes. Endocrinol Diabetes Nutr. 2017;64:471-9.
Chotiyarnwong C, Harnphadungkit K. Epidemiological characteristics of outpatients in cardiac rehabilitation unit, Siriraj Hospital. J Thai Rehabil Med. 2015;25:30-8.
Stoffers HE, Rinkens PE, Kester AD, Kaiser V, Knottnerus JA. The prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease. Int J Epidemiol. 1996;25:282-90.
Papanas N, Tziakas D, Hatzinikolaou E, Chalikias G, Maltezos E, Louridas G, et al. Revisiting the frequency of peripheral arterial disease in patients with coronary artery disease: is there a difference between diabetic and non-diabetic patients? Vasa. 2006; 35:227-31.