Predictors of outcome in stable outpatients with peripheral artery disease

Patients with peripheral artery disease (PAD) are at increased risk for subsequent ischemic events. We used data from the FRENA Registry to find predictors of subsequent myocardial infarction (MI), ischemic stroke, and limb amputation in stable outpatients with PAD. As of January 2012, 1,270 patients with PAD were recruited, of whom 1,042 (82 %) had Fontaine stage II; 113 (8.9 %) stage III; and 115 (9.1 %) stage IV. Over a mean follow-up of 14 months, 35 patients developed MI, 25 had stroke, 39 underwent limb amputation, and 91 died. Among patients with Fontaine stage II, the incidence of MI (2.09 events per 100 patient-years; 95 % CI 1.43–2.97) or stroke (0.93; 95 % CI 0.52–1.56) was similar to that of limb amputation (3.22; 95 % CI 2.37–4.29). On multivariate analysis, patients with diabetes [hazard ratio (HR) 2.09; 95 % CI 1.05–4.18], prior coronary disease (HR 5.35; 95 % CI 2.24–12.8), or atrial fibrillation (HR 3.11; 95 % CI 1.52–6.37) were at increased risk for MI; female (HR 2.94; 95 % CI 1.32–6.67), those with prior stroke (HR 5.21; 95 % CI 1.22–22.2) or atrial fibrillation (HR 3.37; 95 % CI 1.45–7.85) at increased risk for stroke; and female (HR 2.38; 95 % CI 1.23–4.55), those with diabetes (HR 3.50; 95 % CI 1.58–7.73) or advanced stages of PAD were at increased risk for limb amputation. Prior coronary artery disease, diabetes and atrial fibrillation predicted subsequent MI; female gender, prior stroke and atrial fibrillation predicted stroke; and female gender, diabetes, and advanced stages of PAD predicted limb amputation.