Frequency of peripheral arterial disease in patients presented with acute STEMI

Abstract

Background: Peripheral arterial disease (PAD) and coronary artery disease (CAD) are both manifestations of systemic atherosclerosis. In acute ST-elevation myocardial infarction (STEMI), the presence of PAD may reflect a more extensive vascular burden and worse clinical outcomes. The ankle–brachial index (ABI) is a simple, non-invasive tool to assess PAD, yet it remains underutilized in acute coronary care, particularly in high-risk populations such as STEMI patients.

Objective: To determine the frequency of PAD using ABI in patients presenting with acute STEMI and to evaluate its association with clinical outcomes and coronary lesion complexity.

Methods: A prospective cohort study was conducted at the National Institute of Cardiovascular Diseases, Karachi, over six months. A total of 246 patients aged 18–80 years, diagnosed with STEMI and undergoing percutaneous coronary intervention (PCI), were enrolled through non-probability consecutive sampling. ABI was measured bilaterally using Doppler and sphygmomanometer; values ≤0.90 indicated PAD. Data on demographics, comorbidities, echocardiographic findings, and angiographic parameters—including Syntax scores—were recorded. Statistical analysis was performed using SPSS version 21.0, with a p-value <0.05 considered significant.

Results: PAD was detected in 8.9% (right ABI) and 13.4% (left ABI) of STEMI patients. Diabetes was more prevalent in the PAD group (right ABI p=0.039). PAD patients had lower ejection fraction (43.6 ± 7.7%), higher heart failure incidence (44.4%), and reduced PCI success rates (86.4%) compared to those without PAD. CABG planning was significantly higher in PAD-positive patients (40.9%, p=0.042), though Syntax scores did not differ significantly across ABI groups (p=0.592).

Conclusion: PAD is prevalent in STEMI patients and is associated with adverse clinical parameters and more intensive treatment strategies. ABI measurement offers a valuable addition to risk assessment and may guide more comprehensive cardiovascular management.

Keywords: Ankle–Brachial Index, Coronary Artery Disease, Diabetes Mellitus, Myocardial Infarction, Peripheral Arterial Disease, Risk Assessment, Vascular Diseases