BACKGROUND Lower-extremity peripheral artery disease (LE-PAD) and coronary artery disease (CAD) are both pathologically rooted in atherosclerosis, and their shared clinical features regarding the exposure to cardiovascular risk factors have been emphasized. However, comparative data of the two cardiovascular diseases (CVDs) were so far lacking. The purpose of this study was to directly compare the clinical profile between cases undergoing endovascular therapy (EVT) for LE-PAD and those undergoing percutaneous coronary intervention (PCI). METHODS Data were extracted from the nationwide procedural databases of EVT and PCI in Japan (J-EVT and J-PCI) between 2012 and 2017. A total of 1,121,359 cases (103,887 EVT cases for critical limb ischemia [CLI] or intermittent claudication and 1,017,472 PCI cases for acute coronary syndrome [ACS] or stable angina) were analyzed. Heterogeneity in clinical profile between CVDs was evaluated using the C statistic of the logistic regression model for which dependent variable was one CVD versus another, and explanatory variables were clinical profile. When two CVDs were completely discriminated from each other by the developed model, the C statistic (discrimination ability) of the model would be equal to 1, indicating that the two CVDs were completely different in clinical profile. On the other hand, when two CVDs were identical in clinical profile, the developed model would not discriminate them at all, with the C statistic equal to 0.5. RESULTS Mean age was 73.5 ± 9.3 years in LE-PAD patients versus 70.0 ± 11.2 years in CAD patients (P < 0.001). The prevalence of diabetes mellitus and end-stage renal disease was 1.96- and 6.39-times higher in LE-PAD patients than in CAD patients (both P < 0.001). The higher prevalence was observed irrespective of age group. The exposure to other cardiovascular risk factors and the likelihood of cardiovascular risk clustering also varied between the diseases. The between-disease heterogeneity in patient profile was particularly evident between CLI and ACS, with the C statistic equal to 0.833 (95% CI 0.831-0.836). CONCLUSIONS The current study, an analysis based on nationwide procedural databases, confirmed that patient profiles were not identical but rather considerably different between clinically significant LE-PAD and CAD warranting revascularization.

中文翻译：

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下肢外周动脉疾病与冠心病之间的糖尿病和其他心血管危险因素：来自全国数据库的1,121,359例病例分析。

背景技术下肢外周动脉疾病（LE-PAD）和冠状动脉疾病（CAD）均在病理上扎根于动脉粥样硬化，并且已经强调了它们关于暴露于心血管危险因素的共同临床特征。但是，迄今为止尚缺乏两种心血管疾病（CVD）的比较数据。这项研究的目的是直接比较接受LE-PAD血管内治疗（EVT）的患者和经皮冠状动脉介入治疗（PCI）的患者之间的临床特征。方法从2012年至2017年日本全国EVT和PCI程序数据库（J-EVT和J-PCI）中提取数据。共计1,121,359例（重度肢体缺血[CLI]或间歇性lau行103,887例EVT病例，1,017例） ，分析了472例急性冠脉综合征（ACS）或稳定型心绞痛的PCI病例。使用逻辑回归模型的C统计量评估CVD之间的临床分布的异质性，因变量的一个因变量是一个CVD，另一个因变量是临床分布。当通过开发的模型将两个CVD完全区分开时，该模型的C统计量（区分能力）将等于1，表明这两个CVD的临床特征完全不同。另一方面，当两个CVD的临床特征相同时，所建立的模型将根本无法区分它们，C统计量等于0.5。结果LE-PAD患者的平均年龄为73.5±9.3岁，而CAD患者的平均年龄为70.0±11.2岁（P <0.001）。LE-PAD患者的糖尿病和终末期肾脏疾病的患病率比CAD患者高1.96倍和6.39倍（均P <0.001）。不论年龄组，患病率均较高。在这些疾病之间，其他心血管疾病危险因素的暴露程度和心血管疾病危险性聚类的可能性也有所不同。CLI和ACS之间患者病情之间的异质性尤为明显，C统计量等于0.833（95％CI 0.831-0.836）。结论当前的研究是基于全国性程序数据库的分析，证实在具有临床意义的需要进行血运重建的LE-PAD和CAD之间，患者的资料并不完全相同，而是存在很大差异。LE-PAD患者比CAD患者高39倍（均P <0.001）。不论年龄段，患病率均较高。在这些疾病之间，其他心血管疾病危险因素的暴露程度和心血管疾病危险性聚类的可能性也有所不同。CLI和ACS之间患者病情之间的异质性尤为明显，C统计量等于0.833（95％CI 0.831-0.836）。结论当前的研究是基于全国性程序数据库的分析，证实在具有临床意义的需要进行血运重建的LE-PAD和CAD之间，患者的资料并不完全相同，而是存在很大差异。LE-PAD患者比CAD患者高39倍（均P <0.001）。不论年龄段，患病率均较高。在这些疾病之间，其他心血管疾病危险因素的暴露程度和心血管疾病危险性聚类的可能性也有所不同。CLI和ACS之间患者病情之间的异质性尤为明显，C统计量等于0.833（95％CI 0.831-0.836）。结论当前的研究是基于全国性程序数据库的分析，证实在具有临床意义的需要进行血运重建的LE-PAD和CAD之间，患者的资料并不完全相同，而是存在很大差异。在这些疾病之间，其他心血管疾病危险因素的暴露程度和心血管疾病危险性聚类的可能性也有所不同。CLI和ACS之间患者病情之间的异质性尤为明显，C统计量等于0.833（95％CI 0.831-0.836）。结论当前的研究是基于全国性程序数据库的分析，证实在具有临床意义的需要进行血运重建的LE-PAD和CAD之间，患者的资料并不完全相同，而是存在很大差异。在这些疾病之间，其他心血管疾病危险因素的暴露程度和心血管疾病危险性聚类的可能性也有所不同。CLI和ACS之间患者病情之间的异质性尤为明显，C统计量等于0.833（95％CI 0.831-0.836）。结论当前的研究是基于全国性程序数据库的分析，证实在具有临床意义的需要进行血运重建的LE-PAD和CAD之间，患者的资料并不完全相同，而是存在很大差异。