Examining Outcomes in Patients Admitted With Comorbid Peripheral Artery Disease and Microvascular Disease

Abstract

Background Peripheral artery disease (PAD) and microvascular disease (MVD) are highly prevalent conditions that share common risk factors. This observational study aimed to characterize patients with both conditions and determine the impact of comorbid PAD/MVD on outcomes. Methods and Results Patients admitted across 31 states January 2011 through December 2018 with a primary or secondary diagnosis of PAD or MVD were included from the National Readmissions Database and weighted to approximate a national sample. Those age <18 years or with nonatherosclerotic leg injuries were excluded. Patients were divided into 3 groups: PAD‐only, MVD‐only, or comorbid PAD/MVD. Multiple logistic regression was used to evaluate associations with major and minor amputations, major adverse cardiac events, and in‐hospital mortality. Cox regression was used to evaluate associations with readmission within 1 year. The PAD group was used as reference. The final cohort included 33 972 772 admissions: 9.1 million with PAD, 21.3 million with MVD, and 3.6 million with both. Annual admissions for PAD/MVD increased to >500 000 in 2018. Major and minor amputations increased ≈50% for PAD/MVD between 2011 and 2018. Compared with PAD‐only, PAD/MVD was associated with a higher risk for major amputation (odds ratio [OR], 1.30 [95% CI, 1.28–1.32]), minor amputation (OR, 2.15 [95% CI, 2.12–2.18]), major adverse cardiac events (OR, 1.04 [95% CI, 1.03–1.04]), in‐hospital mortality (OR, 1.07 [95% CI, 1.05–1.09]), and readmission (hazard ratio, 1.02 [95% CI, 1.02–1.02]) after adjustment for baseline factors. Conclusions Comorbid MVD is present in a large and growing number of patients with PAD and is associated with augmented risk for adverse outcomes. Further prospective research is merited to understand this vulnerable population.