RESUMO
Silent ischaemic heart disease was looked for by exercise stress testing in 418 patients with chronic obliterative arterial disease of the lower limbs with no clinical or electrocardiographic signs of myocardial ischaemia. In the initial work-up, 6.2% of patients had a positive exercise test and the results were suspect in 9.2% of patients. These patients were followed up for 5 years. There were 42 deaths (10%). The cause of death was cardiovascular in 53.7% of cases (myocardial infarction 40.4%) and malignant disease in 35.7%. During the 5 year follow-up, ischaemic heart disease present as angina pectoris or myocardial infarction in 115 cases (27.5%). Patients who had a positive exercise stress test initially had a particularly high death rate (23%) and developed clinical signs of coronary insufficiency in 57.5% of cases. On the other hand, the peripheral vascular complications were relatively rare in this series: cerebrovascular accidents: 1.4%; retinal vascular accident: 1.1%; carotid surgery: 1.6%; lower limb amputation: 1.9%; lower limb vascular surgery: 17.7%. Silent ischaemic heart disease is very prevalent in patients with obliterative arterial disease of the lower limbs and is a main vital prognostic factor in these patients. These results confirm the need for a complete cardiovascular check-up in all patients with peripheral arterial disease.
