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Peripheral artery disease and outcomes in patients with acute myocardial infarction
AIM: To describe the population of patients with previously diagnosed peripheral artery disease (PAD) experiencing a myocardial infarction (MI) and to investigate 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure hospitalisation) following MI. BAC...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560667/ https://www.ncbi.nlm.nih.gov/pubmed/31245013 http://dx.doi.org/10.1136/openhrt-2018-001004 |
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author | Attar, Rubina Wester, Axel Koul, Sasha Eggert, Svend Andell, Pontus |
author_facet | Attar, Rubina Wester, Axel Koul, Sasha Eggert, Svend Andell, Pontus |
author_sort | Attar, Rubina |
collection | PubMed |
description | AIM: To describe the population of patients with previously diagnosed peripheral artery disease (PAD) experiencing a myocardial infarction (MI) and to investigate 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure hospitalisation) following MI. BACKGROUND: MI patients with PAD constitute a high-risk population with adverse cardiac outcomes. Contemporary real-life data regarding the clinical characteristics of this patient population and clinical event rates following MI remain scarce. METHODS: This observational study included all MI patients presenting with ST-elevation MI or non-ST-elevation MI between 01 January 2005 and 31 December 2014 with (n=4213) and without (n=106 763) a concurrent PAD diagnosis, identified in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and the National Patient Registry (PAD prevalence: 3.8%). Cox proportional hazard models were applied to compare the outcome between the two populations. RESULTS: MI patients with PAD were older and more often burdened with comorbidities, such as diabetes, hypertension and previous MI. After adjustments, PAD was significantly associated with higher rates of MACE (HR 1.35, 95% CI 1.27 to 1.44), mortality (HR 1.59, 95% CI 1.43 to 1.76), reinfarction (HR 1.48, 95% CI 1.32 to 1.66), stroke (HR 1.27, 95% CI 1.05 to 1.53), heart failure (HR 1.29, 95% CI 1.20 to 1.40) and bleeding (HR 1.26, 95% CI 1.09 to 1.47) at 1 year. CONCLUSION: A concurrent PAD diagnosis was independently significantly associated with higher rates of adverse outcomes following MI in a nationwide real-life MI population. The low prevalence of PAD compared with previous studies suggests significant underdiagnosing. Future studies should investigate if PAD screening with ankle–brachial index may increase diagnosing and subsequently lead to improved treatment of polyvascular disease |
format | Online Article Text |
id | pubmed-6560667 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65606672019-06-26 Peripheral artery disease and outcomes in patients with acute myocardial infarction Attar, Rubina Wester, Axel Koul, Sasha Eggert, Svend Andell, Pontus Open Heart Coronary Artery Disease AIM: To describe the population of patients with previously diagnosed peripheral artery disease (PAD) experiencing a myocardial infarction (MI) and to investigate 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure hospitalisation) following MI. BACKGROUND: MI patients with PAD constitute a high-risk population with adverse cardiac outcomes. Contemporary real-life data regarding the clinical characteristics of this patient population and clinical event rates following MI remain scarce. METHODS: This observational study included all MI patients presenting with ST-elevation MI or non-ST-elevation MI between 01 January 2005 and 31 December 2014 with (n=4213) and without (n=106 763) a concurrent PAD diagnosis, identified in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and the National Patient Registry (PAD prevalence: 3.8%). Cox proportional hazard models were applied to compare the outcome between the two populations. RESULTS: MI patients with PAD were older and more often burdened with comorbidities, such as diabetes, hypertension and previous MI. After adjustments, PAD was significantly associated with higher rates of MACE (HR 1.35, 95% CI 1.27 to 1.44), mortality (HR 1.59, 95% CI 1.43 to 1.76), reinfarction (HR 1.48, 95% CI 1.32 to 1.66), stroke (HR 1.27, 95% CI 1.05 to 1.53), heart failure (HR 1.29, 95% CI 1.20 to 1.40) and bleeding (HR 1.26, 95% CI 1.09 to 1.47) at 1 year. CONCLUSION: A concurrent PAD diagnosis was independently significantly associated with higher rates of adverse outcomes following MI in a nationwide real-life MI population. The low prevalence of PAD compared with previous studies suggests significant underdiagnosing. Future studies should investigate if PAD screening with ankle–brachial index may increase diagnosing and subsequently lead to improved treatment of polyvascular disease BMJ Publishing Group 2019-05-12 /pmc/articles/PMC6560667/ /pubmed/31245013 http://dx.doi.org/10.1136/openhrt-2018-001004 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Coronary Artery Disease Attar, Rubina Wester, Axel Koul, Sasha Eggert, Svend Andell, Pontus Peripheral artery disease and outcomes in patients with acute myocardial infarction |
title | Peripheral artery disease and outcomes in patients with acute myocardial infarction |
title_full | Peripheral artery disease and outcomes in patients with acute myocardial infarction |
title_fullStr | Peripheral artery disease and outcomes in patients with acute myocardial infarction |
title_full_unstemmed | Peripheral artery disease and outcomes in patients with acute myocardial infarction |
title_short | Peripheral artery disease and outcomes in patients with acute myocardial infarction |
title_sort | peripheral artery disease and outcomes in patients with acute myocardial infarction |
topic | Coronary Artery Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560667/ https://www.ncbi.nlm.nih.gov/pubmed/31245013 http://dx.doi.org/10.1136/openhrt-2018-001004 |
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