Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction. (August 2017)

• Record Type: Journal Article
• Authors: Eriksson Östman, Maja; Calais, Fredrik; Rosenblad, Andreas; Fröbert, Ole; Leppert, Jerzy; Hedberg, Pär
• Is Part Of: Atherosclerosis. Volume 263(2017)
• Page Start: 53
• Page End: 59
• Publication Date: 2017-08
• Subjects: Extracoronary artery disease -- Myocardial infarction -- Prognosis; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2017.05.027
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI). Methods: In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta. Clinical ECADs were defined as prior strokes, claudication, or extracoronary artery intervention. Subclinical ECADs were defined as the absence of a clinical ECAD in combination with an ABI ≤0.9 or >1.4, carotid artery stenosis, or an abdominal aortic aneurysm. Results: At baseline, subclinical and clinical ECADs were prevalent in 21.6% and 14.4% of the patients, respectively. Patients with ECADs received evidence-based medication more often at admission but similar medications at discharge compared with patients without ECADs. During a median follow-up of 5.2 years, 166 patients experienced endpoints of hospitalization for AMI, heart failure, stroke, or cardiovascular death. With ECAD-free cases as reference and after adjustment for risk factors, a clinical ECAD (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34–3.27, p= 0.001), but not a subclinical ECAD (HR 1.35, 95% CI 0.89–2.05, p= 0.164), was significantly associated with worse outcomes. Conclusions: Despite receiving similar evidence-based medication at discharge, patients with clinical ECAD, but not patients with a subclinical ECAD, had worse long-term prognosis than patients without an ECAD after AMI. Highlights: Extracoronary artery disease (ECAD) in acute myocardial infarction (AMI) suggests poor prognosis. Earlier studies found patients with AMI and concomitant ECAD less often receive guideline-recommended therapy. In our findings, AMI patients with symptomatic ECAD had worse prognosis than patients without ECAD despite similar medical therapy. The prognostic impact of subclinical ECAD was not statistically significant.