The impact of peripheral artery disease on major adverse cardiovascular events following myocardial infarction. (15th November 2021)

• Record Type: Journal Article
• Authors: Andersen, Patricia; Kragholm, Kristian; Torp-Pedersen, Christian; Jensen, Svend Eggert; Attar, Rubina
• Is Part Of: International journal of cardiology. Volume 343(2021)
• Page Start: 131
• Page End: 137
• Publication Date: 2021-11-15
• Subjects: Peripheral artery disease -- Myocardial infarction -- Major adverse cardiovascular events; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.08.053
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Peripheral artery disease (PAD) constitute a high-risk with adverse clinical outcomes. We aimed to investigate the cardiovascular outcomes following myocardial infarction (MI). Methods and results: This nationwide, Danish register-based follow-up study includes all patients experiencing an MI between 2000 and 2017. Patients with and without PAD were compared. Multivariable logistic regression was used to derive relative risks of 1-year major adverse cardiovascular events (MACE; all-cause mortality, reinfarction, stroke or heart failure). Individual components, cardiovascular mortality, and bleeding, standardized to age, sex and comorbidity distributions of all patients were assessed. MI patients with PAD (n = 5083, 2.9%) were older and more comorbid compared to patients without PAD (n = 174, 673). After standardization, PAD was associated with higher 1-year relative risks of MACE (RR 1.21 [95% CI 1.17;1.25]), all-cause (RR 1.29 [95% CI 1.24;1.35]) and cardiovascular mortality (RR 1.3 [95% CI 1.24;1.36]), reinfarction (RR 1.17 [95% CI 1.11;1.22]), stroke (RR 1.12 [95% CI 0.92;1.32]), heart failure (RR 1.22 [95% CI 1.12;1.32]), and bleeding episodes (RR 1.25 [95% CI 1.04, 1.46]). Similar results were seen in 30-day survivors after adjustment for antithrombotic post-discharge medication for MACE (RR 1.25 [95% CI 1.20, 1.31]), all-cause mortality (RR 1.47 [95% CI 1.37, 1.57], cardiovascular mortality (RR 1.49 [95% CI 1.37, 1.61]), reinfarction (RR 1.17 [95% CI 1.08, 1.12]) and heart failure (RR 1.22 [95% CI 1.12, 1.32]). Conclusion: Comparing to patients without PAD, patients with PAD had increased 1-year relative risk of MACE, all-cause mortality, reinfarction, stroke, heart failure, cardiovascular mortality and bleeding following MI. The low prevalence of PAD is suggestive of considerable under-diagnosing. Highlights: The prevalence of peripheral artery disease (PAD) in this Danish study population is lower than previously reported [11, 12] The low prevalence suggests considerable under-diagnosing in the study population Selected individuals with concomitant PAD had an increased 1-year relative risk of adverse events compared to those without PAD Similar findings were seen in patients 30 days after MI adjusted for discharge medication suggesting a high-risk population