Original articleClinical outcome in patients with peripheral artery disease. Results from a prospective registry (FRENA)
Introduction
Even in the absence of a history of coronary artery disease (CAD), patients with peripheral artery disease (PAD) have a similar risk to die from a cardiovascular cause as patients with previous CAD.[1], [2], [3] Indeed, these patients are usually considered for secondary prevention strategies comparable to those for patients with CAD or cerebrovascular disease (CVD).[4], [5] However, despite its frequency and severity, data on cardiovascular morbidity and mortality of patients with symptomatic PAD are scarce.[6], [7], [8], [9], [10], [11]
The FRENA (Factores de Riesgo y ENfermedad Arterial) Registry is an ongoing, multicentre, observational registry of consecutive patients with symptomatic ischemic disease in the heart, brain, and/or major peripheral arteries. The aim of this study was to compare the incidence of major cardiovascular events during a 12-month follow-up period in patients with PAD, CAD or CVD.
Section snippets
Inclusion criteria
Participating hospitals in the FRENA registry prospectively enroll consecutive outpatients with cardiovascular disease meeting at least one recent (< 3 months prior to enrollment) episode of CAD (manifesting as angina or acute coronary syndrome); CVD (manifesting as transient ischemic attack or ischemic stroke); or PAD (either intermittent claudication with an ankle–brachial index < 0.9, or previous vascular intervention or limb amputation for PAD). The Fontaine classification was used for
Results
As of September 2005, a total of 1350 outpatients with symptomatic atherothrombotic disease had been enrolled in FRENA in 20 participating Spanish centers. One year later, 1265 (94%) had finished their 12-month follow-up. Of those who withdrew, 66 patients did so because of missed site visits and 19 because their enrolling physicians had withdrawn from the registry. Of the 1265 patients who finished, 417 (33%) had PAD (intermittent claudication 327, ischemia at rest 90); 474 (37%) had CAD
Discussion
The data in this analysis, obtained from a prospective series of consecutive patients in the FRENA registry, confirm that patients with PAD are at increased risk for major cardiovascular events during follow-up, independently of the presence of other covariates, such as patient's age, gender or underlying diseases. Furthermore, we found that this incidence increased with the severity of the symptoms, ranging from 8.7 events per 100 patient-years in patients in Fontaine stage IIa (intermittent
Learning points
Patients with PAD had an increased incidence of major cardiovascular events. Compared to patients with CAD or CVD they had a similar incidence of myocardial infarction or stroke, but a higher incidence of critical limb ischemia, limb amputation and death. This incidence increased with the severity of the symptoms of PAD.
Acknowledgements
We express our gratitude to S & H Medical Science Service for their logistic and administrative support. We thank Prof. Salvador Ortíz, Universidad Autónoma de Madrid and Statistical Advisor S & H Medical Science Service for the statistical analysis of the data presented in this paper.
We would like to thank Sanofi-Aventis for supporting this Registry with an unrestricted educational grant.
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