Impact of Prior Peripheral Arterial Disease and Stroke on Outcomes of Acute Coronary Syndromes and Effect of Evidence-Based Therapies (from the Global Registry of Acute Coronary Events)

Mukherjee, Debabrata; Eagle, Kim A.; Kline–Rogers, Eva; Feldman, Laurent J.; Juliard, Jean-Michel; Agnelli, Giancarlo; Budaj, Andrzej; Avezum, Álvaro; Allegrone, Jeanna; FitzGerald, Gordon; Steg, Philippe Gabriel

doi:10.1016/j.amjcard.2007.02.046

Cited by 129 publications

(102 citation statements)

References 13 publications

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“…The present study confirms the findings from several other clinical trials and databases that patients admitted with ACS and a history of stroke or TIA have an increased risk of adverse ischemic events, 7 mortality, 8 and bleeding, 9 even after multivariable adjustment for baseline differences. Despite good adherence to guidelines concerning pharmacological therapies and invasive procedures, patients with prior stroke or TIA demonstrated a doubled mortality rate and a 3 and 4 times higher risk for stroke and intracranial bleeding, respectively.…”

Section: Discussionsupporting

confidence: 79%

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack

et al. 2012

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for the PLATO Study GroupBackground-Patients with acute coronary syndromes and history of stroke or transient ischemic attack (TIA) have an increased rate of recurrent cardiac events and intracranial hemorrhages. Methods and Results-We evaluated treatment effects of ticagrelor versus clopidogrel in patients with acute coronary syndrome with and without a history of prior stroke or TIA in the PLATelet inhibition and patient Outcomes (PLATO) trial. Of the 18 624 randomized patients, 1152 (6.2%) had a history of stroke or TIA. Such patients had higher rates of myocardial infarction (11.5% versus 6.0%), death (10.5% versus 4.9%), stroke (3.4% versus 1.2%), and intracranial bleeding (0.8% versus 0.2%) than patients without prior stroke or TIA. Among patients with a history of stroke or TIA, the reduction of the primary composite outcome and total mortality at 1 year with ticagrelor versus clopidogrel was consistent with the overall trial results: 19.0% versus 20.8% (hazard ratio, 0.87; 95% confidence interval, 0.66 -1.13; interaction Pϭ0.84) and 7.9% versus 13.0% (hazard ratio, 0.62; 95% confidence interval, 0.42-0.91). The overall PLATO-defined bleeding rates were similar: 14.6% versus 14.9% (hazard ratio, 0.99; 95% confidence interval, 0.71-1.37), and intracranial bleeding occurred infrequently (4 versus 4 cases, respectively). Conclusions-Patients with acute coronary syndrome with a prior history of ischemic stroke or TIA had higher rates of clinical outcomes than patients without prior stroke or TIA. However, the efficacy and bleeding results of ticagrelor in these high-risk patients were consistent with the overall trial population, with a favorable clinical net benefit and associated impact on mortality. Clinical Trial Registration-URL: http://www.clinicatrials.gov. Unique identifier: NCT00391872.

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Section: Discussionsupporting

confidence: 79%

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack

et al. 2012

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“…The cumulative event rates were compared between the three groups classified according to the ABI value: patients with an ABI of 0.9 vs. an ABI between 0.9 and 1.056 vs. an ABI of ≥ 1.057. Consequently, there were no differences in the cumulative event rate including 41,108 patients with ACS showed that the patients with PAD experienced more cardiovascular events than those without prior PAD during their hospital stay 16) and six months of follow-up 17) . Similarly, Morillas et al analyzed 1,054 patients hospitalized for ACS and reported that the patients with clinical PAD had higher rates of myocardial infarction, angina and heart failure than the subjects with subclinical PAD or those without PAD during the one year of follow-up 9) .…”

Section: Associations Between the Abi Values And Clinical Outcomesmentioning

confidence: 99%

Prognostic Value of the Ankle-Brachial Index in Patients Undergoing Drug-Eluting Stent Implantation

Kim

Seo

Chung

et al. 2015

JAT

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Aim: Limited data are available regarding the prognostic value of the brachial-ankle index (ABI) in patients with a history of drug-eluting stent (DES) implantation. This study sought to determine the relationship between the ABI and coronary events in patients with DES. Methods: A total of 322 patients who underwent both DES implantation and ABI measurement during initial hospitalization were reviewed. Cardiovascular events, including cardiac death, non-fatal acute myocardial infarction and coronary revascularization, were assessed. Results: During the mean follow-up period of 298 58 days, there were 32 cases of cardiovascular events (9.9%). The patients with a lower ABI had more events (2.8% in the highest tertile versus 10.3% in the middle tertile versus 16.8% in the lowest tertile, p 0.001). According to the multiple Cox regression analysis, the ABI was independently associated with clinical events (the lowest tertile versus the highest tertile of ABI, hazard ratio: 6.35, 95% confidence interval: 1.37-29.32, p 0.018). In addition, the cumulative event rate according to the ABI tertile differed significantly in the Kaplan-Meier curves (log-rank p 0.009), whereas the receiver-operating characteristic curve analysis showed a sensitivity and specificity for predicting cardiovascular events of 62.5% and 66.2%, respectively, with an ABI of 1.057 as the best cut-off value. Conclusions: A lower ABI is associated with poorer cardiovascular outcomes in patients with DES implantation. As a simple and non-invasive parameter, the ABI has the benefit of predicting future cardiovascular events in this population. J Atheroscler Thromb, 2015; 22:27-37.

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“…However, compared to data from the Gusto IIb study (PAD ratio: 7.3 % in male and 6.2 % in female STEMI) [20], the French Alliance Project (PAD ratio of 8 % in AMI) [2], the GRACE registry (9.4 % PAD in ACS) [7], or data from the Worcester area (13.5 % PAD in AMI) [21], these PAD ratios appear relatively low. In the German MONICA/KORA registry, a PAD ratio of 10 % in female and 10.7 % in male AMI patients was reported, although patients aged ≥ 75 years were excluded from the registry [22].…”

Section: Discussionmentioning

confidence: 99%

“…Yet, PAD is not considered a risk factor in many high-impact randomized clinical trials on acute coronary syndrome [8 - 12], refl ecting the current practice of PAD not being routinely assessed in patients with AMI and remaining under-diagnosed, especially in subclinical stages [13,14]. Subclinical PAD has previously been reported to negatively aff ect patient prognosis, and treatment of PAD has been shown to be benefi cial at any stage of disease [7,14]. In view of the worldwide aging population, the prevalence of PAD is predicted to increase, constituting a medical socioeconomic challenge for health care providers, as recently shown in a nationwide analysis in Germany [15].…”

Section: Introductionmentioning

confidence: 99%

Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting

Freisinger

Malyar

Reinecke

2016

Vasa

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Summary:Background: Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular morbidity and mortality. The objective of this nationwide analysis was to explore the association of PAD with in-hospital mortality in patients hospitalized for acute myocardial infarction (AMI). Patients and methods: Data on all in-patient hospitalizations in Germany are continuously transferred to the Federal Statistical Offi ce (DESTATIS), as required by federal law. These case-based data on AMI in the years 2005, 2007 and 2009 were analyzed regarding ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) as the primary diagnoses and concomitant PAD as the secondary diagnosis with respect to age and gender related disparity. Results: We analyzed 619,103 AMI cases, including 270,026 (43.6 %) with STEMI and 349,077 (56.4 %) with NSTEMI. The PAD ratio was 3.4 % in STEMI and 5.7 % in NSTEMI. In STEMI, in-hospital mortality was 15.6 % in cases with PAD vs. 12.0 % without, and 12.0 % vs. 9.8 % in NSTEMI, respectively (P < 0.001; 2009). Although female gender was associated with a signifi cantly higher in-hospital mortality, the presence of PAD particularly negatively affected in-hospital mortality in men (+ 60 % male vs -11 % female in STEMI; + 33 % male vs -3 % female in NSTEMI). Conclusions: Our data demonstrate the adverse impact of concomitant PAD on in-hospital mortality in AMI, in a large-scale, real-world scenario. Further research, particularly with a focus on gender, is needed to identify diagnostic and therapeutic measures to reduce the remarkably high in-hospital mortality of AMI patients with concomitant PAD.

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Impact of Prior Peripheral Arterial Disease and Stroke on Outcomes of Acute Coronary Syndromes and Effect of Evidence-Based Therapies (from the Global Registry of Acute Coronary Events)

Cited by 129 publications

References 13 publications

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack

Prognostic Value of the Ankle-Brachial Index in Patients Undergoing Drug-Eluting Stent Implantation

Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting

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