Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease

Abstract

There are a number of devastating complications associated with peripheral artery disease, including limb amputations and acute limb ischemia. Despite the overlap, atherosclerotic diseases have distinct causes that need to be differentiated and managed appropriately. In coronary atherosclerosis, thrombosis is often precipitated by rupture or erosion of fibrous caps around atheromatous plaques, which leads to acute coronary syndrome. Regardless of the extent of atherosclerosis, peripheral artery disease manifests itself as thrombosis. Two-thirds of patients with acute limb ischemia have thrombi associated with insignificant atherosclerosis. A local thrombogenic or remotely embolic basis of critical limb ischemia may be explained by obliterative thrombi in peripheral arteries of patients without coronary artery-like lesions. Studies showed that thrombosis of the above-knee arteries was more commonly due to calcified nodules, which are the least common cause of luminal thrombosis associated with acute coronary events in patients with acute coronary syndrome. Cardiovascular mortality was higher in peripheral artery disease without myocardial infarction/stroke than in myocardial infarction/stroke without peripheral artery disease. The aim of this paper is to gather published data regarding the disparities of acute coronary syndrome with and without peripheral artery disease in terms of pathophysiology and mortality.

Analysis of Mortality from Peripheral Artery Disease from 2011 to 2020 by Region in the Republic of Croatia

“…[53][54][55][56] Additionally, the mortality from PAD, as with acute coronary syndrome, is ascribable to the natural course of the disease, but can also be caused by medical, endovascular, or surgical interventions, which necessitates differentiating and recording spontaneous unwanted outcomes as opposed to unwanted outcomes associated with medical interventions. 57,58 The present study had certain advantages and disadvantages, the latter being the study limitations and the possibility of systemic errors. Its greatest advantage is the fact that this was the first study to quantify the regional differences in PAD-related mortality.…”

“…53-56 Također, mortalitet od PAB-a, kao i od akutnoga koronarnog sindroma, pripisiv je prirodnom tijeku bolesti, ali isto tako može biti uzrokovan medicinskim, endovaskularnim ili kirurškim intervencijama, pa je stoga potrebno razlikovati i bilježiti spontane neželjene ishode od neželjenih ishoda povezanih s intervencijama. 57,58 Ovo istraživanje ima određene prednosti i nedostatke, što se u potonjem slučaju odnosi na ograničenja istraživanja i mogućnost postojanja sustavne pogreške. Najveća je prednost u tome što su ovim istraživanjem prvi put kvantificirane regionalne razlike u mortalitetu od PAB-a.…”

Peripheral Arterial Disease in the Context of Acute Coronary Syndrome: A Comprehensive Analysis of Its Influence on Ejection Fraction Deterioration and the Onset of Acute Heart Failure

“…Given the global population’s aging, PAD is foreseen to become more prevalent. Men have a higher risk of experiencing the condition than women, particularly in cases of advanced disease [ 1 ].…”