TO STUDY OCCURRENCE OF PERIPHERAL ARTERIAL DISEASE IN YOUNG PATIENTS WITH CORONARY ARTERY DISEASE USING ANKLE BRACHIAL INDEX -A SMS HOSPITAL BASED OBSERVATIONAL STUDY

Background: Coronary artery disease (CAD) and peripheral arterial disease (PAD) both are manifestations of systemic atherosclerosis. Many patients with CAD have associated PAD however, many patients are asymptomatic and thus remain underdiagnosed. Currently, little is known about the actual incidence and clinical implications of asymptomatic PAD in young patients less than 50-year-old undergoing coronary angiography in Indian population, so we will conduct this study to assess the prevalence of previously unrecognized PAD among patients with suspected ischemic heart disease undergoing coronary angiography, and to determine the relationship among PAD, severity of coronary angiographic stenosis, and major cardiovascular risk factors, in western Indian population. Method: This is an observational study conducted at a tertiary referral hospital. A total of 395 patients referred for coronary angiography without a prior diagnosis of PAD, between January 2023 to June 23 who fulfilling eligibility criteria of study, were included. Patients were evaluated through detailed medical history taking, a questionnaire survey to assess symptoms and functional status, ankle-brachial index (ABI) measurement, and coronary angiography. PAD was considered present if the ABI was< 0.90 in either leg. Result: In all patients, the prevalence of previously unrecognized PAD was 5.8%. There was significant difference between men and women (7.2% vs 1.1%, P=0.027). Abnormal angiographic results were seen in 63% (249 of 395). The prevalence of PAD was 7.2% in patients with abnormal coronary angiographic result, higher than that in patients with normal results but not statistically significant (3.2%, P=0.119). Patients with PAD were significantly older, and had higher rates of hypertension, dyslipidaemia, diabetes mellitus, current smoking, history of CAD than patients without PAD demonstrating high occurrence of PAD strongly associated with conventional risk factor for CAD. The occurrence of asymptomatic PAD was more among stable ischemic heart disease group(p=0.04). In our analysis, patients with PAD had a more severe form of CAD manifested by a higher frequency of multivessel coronary disease(p=0.002). Conclusion: The high occurrence of asymptomatic PAD in young patients with CAD confirms the importance of active screening for PAD by using ABI even in young patients. Routine determination of ABI in the clinical evaluation of all patients with CAD may helpful inidentifyhigh-risk patients.