THE IMPACT OF PLATELET-FIBRIN CLOT STRENGTH AND INFLAMMATION ON INCIDENCE OF PERIPHERAL ARTERY DISEASE AND CLINICAL OUTCOMES IN PATIENTS WITH SIGNIFICANT CORONARY ARTERY DISEASE

초록

Background:PAD patients have widespread atherosclerosis and increased risk of CV events. However, the impact of clot strength and inflammation levels on incidence and adverse CV events of PAD remains uncertain.Methods:We evaluated 1,667 patients who underwent PCI for significant coronary artery disease. Platelet-fibrin clot strength was indicated with MAthrombin (maximal amplitude measured by thromboelastography) and inflammation was measured by hs-CRP. PAD was defined with abnormal ABI (≤ 0.9 or > 1.4) before PCI. MACE was defined as a composite of CV death, nonfatal MI or nonfatal stroke.Results:PAD was observed in 220 patients (12.1%). In the multivariate analysis, high levels of clot strength (MAthrombin ≥ 68 mm: OR, 1.75; 95% CI, 1.23 to 2.48; P = 0.002) and inflammation (hs-CRP ≥ 4.2 mg/dL: OR, 2.30; 95% CI, 1.55 to 3.41; P < 0.001) were significantly associated with PAD occurrence. During the follow-up post-PCI (median, 26 months), MACE was more frequently occurred in patients with vs. without PAD (18.7% vs. 6.4% at 3 years; HRadj, 1.77; 95% CIadj, 1.07 to 2.92; Padj = 0.027). Furthermore, combining presence of PAD and increased clot strength (or high inflammation level) significantly increased the risk of post-PCI MACE (Figure).Conclusion:This study is the first to show the impact of clot strength and inflammation on incidence and clinical outcomes in PAD patients. Whether medical treatment to control these risk factors can improve clinical outcomes in PAD patients deserves the further study.