Peripheral Artery Disease in Patients Presenting with Acute Coronary Syndrome in Hill Population of Northern India

Abstract

Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the serious presentations of the atherosclerotic disease spectrum. PAD due to atherosclerotic disease can lead to significant morbidity and mortality with significant medical and economic burden. Aim: To study the prevalence of PAD in patients presenting with ACS in the Hill population of Northern India. Materials and Methods: Patients presenting with ACS, with acute chest pain, Electrocardiogram (ECG) changes and elevated troponins were enrolled in the study. The presence of PAD was assessed with MESI Ankle Branchial Measuring Device (MESI ABPI MD® Slovenia EU) system which uses plethysmographic sensors with an inbuilt software that automatically calculates ABI with accuracy. Patients with ABI <0.91 were further evaluated by Computed Tomography (CT) Angiography of lower limb vessels. Results: A total of 288 patients were included in the study. There were 238 (82.6%) males and 50 (17.4%) females. Majority of patients had hypertension (214, 74.3%) as the risk factor. ST-Elevation Myocardial Infarction (STEMI) was seen in 197 (68.4%) and Non-ST Elevation Myocardial Infarction (NSTEMI) in 91 (31.6%). Coronary angiography was done in 240 patients. Single vessel disease was seen in 135 (56.2%), double vessel disease in 69 (28.8%) and triple vessel disease in 36 (15%) cases. Out of overall 288 patients 9 (3.12%) had borderline ABI (ABI- >0.9 and ≤1.0) and 4 (1.38%) had abnormal ABI (ABI <0.9). CT angiography of 3 out of 4 patients with ABI <0.9 showed significant atherosclerosis of lower limb vessels. Conclusion: There was very low prevalence of PAD with ACS in this study population.