Association of Below-the-Knee Lesions With Occult Coronary Artery Disease in Patients With Lower Extremity Artery Disease Undergoing Endovascular Therapy.

BACKGROUND: In patients with lower extremity artery disease (LEAD), coexisting coronary artery disease (CAD) is common, but the angiographic features associated with occult CAD remain poorly characterized. We performed a hypothesis-generating angiographic phenotyping analysis to examine whether lower extremity lesions treated with endovascular therapy (EVT), particularly below-the-knee (BK) lesions, were associated with coexisting occult CAD on preprocedural coronary computed tomography angiography (CCTA) in patients undergoing EVT.

METHODS AND RESULTS: Among 223 consecutive CCTA-screened LEAD patients without prior coronary revascularization, occult CAD (≥50% stenosis) was present in 127 (57.0%). In multivariable analysis, diabetes mellitus (adjusted odds ratio [aOR] 1.93, P=0.030) and EVT-treated BK lesions (aOR 3.27, P=0.034) remained associated with occult CAD after adjustment; the BK association was based on a small subgroup (n=32). During a mean follow-up of 716 days, occult CAD was associated with major adverse cardiovascular events (MACE) in univariable Cox analysis (hazard ratio 2.59, 95% CI 1.04-6.47, P=0.041), but did not persist after exploratory Firth's penalized adjustment for diabetes mellitus and hemodialysis (adjusted hazard ratio 2.01, 95% CI 0.85-5.39, P=0.114).

CONCLUSIONS: In this hypothesis-generating angiographic phenotyping analysis of CCTA-eligible LEAD patients undergoing EVT, EVT-treated BK lesions emerged as a candidate angiographic feature associated with coexisting occult CAD. An independent prognostic effect of occult CAD on MACE was not established. These exploratory findings require validation in larger prospective cohorts.