Patients with peripheral artery disease (PAD) are at heightened risk of ischemic complications and mortality. The combination of symptomatic PAD and coronary artery disease (CAD) is associated with further heightened ischemic risk beyond that associated with symptomatic disease in either vascular bed alone. It is uncertain whether the heightened risk of major adverse cardiovascular events (MACE) observed in patients with CAD and concomitant PAD is a function of PAD as a disease state or whether PAD is a potent integrative marker of global risk. It is clear, however, that the high rates of major adverse limb events such as acute limb ischemia (ALI), critical limb ischemia, and progressive claudication experienced by patients with PAD are a direct function of the atherosclerotic burden in their limbs. In this issue of JAMA Cardiology, Franzone et al1 present important data describing the risk of MACE associated with the presence of PAD in patients undergoing percutaneous coronary intervention (PCI) and how this risk may be modified by more potent antithrombotic therapy. These data will be helpful to clinicians looking to select patients with coronary disease who are at especially high risk and may benefit from intensive therapies for MACE reduction. They also, however, highlight a need to more clearly ascertain and describe limb morbidity in trials studying therapies to reduce ischemic risk in PAD populations.
Marc P. Bonaca. Antithrombotic Therapy in Patients With Peripheral Artery Disease. JAMA Cardiol. 2016;1(7):803–804. doi:10.1001/jamacardio.2016.2797