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Peripheral arterial disease is associated with higher mortality in patients with incident acute myocardial infarction

  • Lisa Dinser
    Affiliations
    Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstraße 2, 86156 Augsburg, Germany

    Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany

    Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometrics and Epidemiology, Marchioninistraße 15, 81377 München, Germany
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  • Christa Meisinger
    Affiliations
    Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany

    Ludwig-Maximilians-Universität München, Chair of Epidemiology, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany
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  • Ute Amann
    Affiliations
    Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstraße 2, 86156 Augsburg, Germany

    Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany

    Ludwig-Maximilians-Universität München, Chair of Epidemiology, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany
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  • Margit Heier
    Affiliations
    Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstraße 2, 86156 Augsburg, Germany

    Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
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  • Christian Thilo
    Affiliations
    Central Hospital of Augsburg, Department of Internal Medicine I — Cardiology, Stenglinstraße 2, 86156 Augsburg, Germany
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  • Bernhard Kuch
    Affiliations
    Central Hospital of Augsburg, Department of Internal Medicine I — Cardiology, Stenglinstraße 2, 86156 Augsburg, Germany

    Hospital of Nördlingen, Department of Internal Medicine/Cardiology, Stoffelsberg 4, 86720 Nördlingen, Germany
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  • Annette Peters
    Affiliations
    Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
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  • Inge Kirchberger
    Correspondence
    Corresponding author at: Ludwig-Maximilians-Universität München, Chair of Epidemiology, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg.
    Affiliations
    Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstraße 2, 86156 Augsburg, Germany

    Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany

    Ludwig-Maximilians-Universität München, Chair of Epidemiology, UNIKA-T Augsburg, Neusässer Str. 47, 86156 Augsburg, Germany

    Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERcv), Spain
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Published:January 05, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.007

      Highlights

      • Peripheral arterial disease is not significantly associated with 28-day case fatality after acute myocardial infarction.
      • Peripheral arterial disease is significantly associated with long-term mortality after acute myocardial infarction.
      • Patients with PAD younger than 63 years have the highest long-term mortality risk after AMI among all subgroups.

      Abstract

      Background

      Little data is available on short- and long-term survival in patients with peripheral arterial disease (PAD) after acute myocardial infarction (AMI). We aimed to examine the association of PAD and 28-day case fatality as well as long-term mortality in a population-based sample of patients with incident AMI.

      Methods

      In this secondary analysis of data from the German MONICA/KORA Myocardial Infarction Registry 4307 patients aged 28–74 years with incident AMI with and without history of PAD (information derived from medical chart) were included. Data were collected between 2000 and 2008. Patients were followed-up until December 2011. Associations between PAD and 28-day case fatality were examined via multivariable logistic regression models, between PAD and long-term mortality with Cox proportional hazards regression models, respectively.

      Results

      From 303 (8.9%) patients with PAD, 22 (7.3%) died within 28-days post-AMI in contrast to 96 (2.9%) of patients without PAD. However, the fully adjusted model (OR 1.55, 95% CI 0.89–2.70) revealed no significant association. Long-term follow-up (median 5.7 years) yielded 100 (32.4%) versus 483 (14.4%) cases of deaths among patients with and without PAD, respectively. This association was significant (fully adjusted model: HR 1.70, 95% CI 1.35–2.13), persisted up to 11 years after AMI and was present in all subgroups according to age, sex and history of diabetes. The highest long-term mortality risk was found for patients younger than 63 years with PAD (HR 2.19; 95% CI 1.41–3.39).

      Conclusion

      AMI patients with PAD differ considerably from their counterparts without PAD in terms of long-term survival.

      Keywords

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      References

        • Alzamora M.T.
        • Forés R.
        • Baena-Díez J.M.
        • et al.
        The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population.
        BMC Public Health. 2010; 10
        • Diehm C.
        • Schuster A.
        • Allenberg J.R.
        • et al.
        High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study.
        Atherosclerosis. 2004; 172: 95-105
        • Mehlsen J.
        • Wiinberg N.
        • Joergensen B.S.
        • Schultz-Larsen P.
        High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event.
        Blood Press. 2010; 19: 308-312
        • Perk J.
        • de Backer G.
        • Gohlke H.
        • et al.
        European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).
        Atherosclerosis. 2012; 223: 1-68
        • Reiner Z.
        • Catapano A.L.
        • de Backer G.
        • et al.
        ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).
        Eur Heart J. 2011; 32: 1769-1818
        • Spencer F.A.
        • Lessard D.
        • Doubeni C.
        • Yarzebski J.
        • Gore J.M.
        • Goldberg R.J.
        Treatment practices and outcomes of patients with established peripheral arterial disease hospitalized with acute myocardial infarction in a community setting.
        Am Heart J. 2007; 153: 140-146
        • Inglis S.C.
        • Bebchuk J.
        • Al-Suhaim S.A.
        • et al.
        Peripheral artery disease and outcomes after myocardial infarction: an individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT.
        Int J Cardiol. 2013; 168: 1094-1101
        • Froehlich J.B.
        • Mukherjee D.
        • Avezum A.
        • et al.
        Association of peripheral artery disease with treatment and outcomes in acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE).
        Am Heart J. 2006; 151: 1123-1128
        • Saw J.
        • Bhatt D.L.
        • Moliterno D.J.
        • et al.
        The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials.
        J Am Coll Cardiol. 2006; 48: 1567-1572
        • Bhatt D.L.
        • Peterson E.D.
        • Harrington R.A.
        • et al.
        Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes.
        Eur Heart J. 2009; 30: 1195-1202
        • Kirchberger I.
        • Amann U.
        • Heier M.
        • Kuch B.
        • Thilo C.
        • Peters A.
        • et al.
        Presenting symptoms, pre-hospital delay time and 28-day case fatality in patients with peripheral arterial disease and acute myocardial infarction from the MONICA/KORA Myocardial Infarction Registry.
        Eur J Prev Cardiol. 2017 Feb; 24: 265-273https://doi.org/10.1177/2047487316676123
        • Subherwal S.
        • Patel M.R.
        • Kober L.
        • et al.
        Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study.
        Eur J Prev Cardiol. 2015; 22: 317-325
        • Al-Thani H.A.
        • El-Menyar A.
        • Zubaid M.
        • et al.
        Peripheral arterial disease in patients presenting with acute coronary syndrome in six middle eastern countries.
        Int J Vasc Med. 2011; 2011: 815902
        • Guerrero M.
        • Harjai K.
        • Stone G.W.
        • et al.
        Usefulness of the presence of peripheral vascular disease in predicting mortality in acute myocardial infarction patients treated with primary angioplasty (from the Primary Angioplasty in Myocardial Infarction Database).
        Am J Cardiol. 2005; 96: 649-654
        • Meizels A.
        • Zeitoun D.M.
        • Bataille V.
        • et al.
        Impact of polyvascular disease on baseline characteristics, management and mortality in acute myocardial infarction. The Alliance project.
        Arch Cardiovasc Dis. 2010; 103: 207-214
        • Mukherjee D.
        • Eagle K.A.
        • Kline-Rogers E.
        • et al.
        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).
        Am J Cardiol. 2007; 100: 1-6
        • Jeremias A.
        • Gruberg L.
        • Patel J.
        • Connors G.
        • Brown D.L.
        Effect of peripheral arterial disease on in-hospital outcomes after primary percutaneous coronary intervention for acute myocardial infarction.
        Am J Cardiol. 2010; 105: 1268-1271
        • Freisinger E.
        • Malyar N.M.
        • Reinecke H.
        Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting.
        Vasa. 2016; 45: 169-174https://doi.org/10.1024/0301-1526/a000512
        • Meisinger C.
        • Hoermann A.
        • Heier M.
        • Kuch B.
        • Lowel H.
        Admission blood glucose and adverse outcomes in non-diabetic patients with myocardial infarction in reperfusion era.
        Int J Cardiol. 2006; 113: 229-235
        • Kuch B.
        • Heier M.
        • von Scheidt W.
        • Kling B.
        • Hoermann A.
        • Meisinger C.
        20-year trends in clinical characteristics, therapy and short-term prognosis in acute myocardial infarction according to presenting electrocardiogram the MONICA/KORA AMI Registry (1985–2004).
        J Intern Med. 2008; 264: 254-264
        • Patel M.R.
        • Becker R.C.
        • Wojdyla D.M.
        • et al.
        Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: data from the PLATO Trial.
        Eur J Prev Cardiol. 2015; 22: 734-742
        • Owens C.D.
        • Conte M.S.
        Medical management of peripheral arterial disease: bridging the “gap”?.
        Circulation. 2012; 126: 1319-1321
        • Hirsch A.T.
        • Criqui M.H.
        • Treat-Jacobson D.
        • et al.
        Peripheral arterial disease detection, awareness, and treatment in primary care.
        JAMA. 2001; 286: 1317-1324
        • Hirsch A.T.
        • Haskal Z.J.
        • Hertzer N.R.
        • Bakal C.W.
        • Creager M.A.
        • Halperin J.L.
        • et al.
        ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation.
        Circulation. 2006 Mar 21; 113: e463-654
        • Cotter G.
        • Cannon C.P.
        • McCabe C.H.
        • et al.
        Prior peripheral arterial disease and cerebrovascular disease are independent predictors of adverse outcome in patients with acute coronary syndromes: are we doing enough? Results from the Orbofiban in Patients with Unstable Coronary Syndromes-Thrombolysis In Myocardial Infarction (OPUS-TIMI) 16 study.
        Am Heart J. 2003; 145: 622-627
        • Subherwal S.
        • Bhatt D.L.
        • Li S.
        • et al.
        Polyvascular disease and long-term cardiovascular outcomes in older patients with non-ST-segment-elevation myocardial infarction.
        Circ Cardiovasc Qual Outcomes. 2012; 5: 541-549
        • Januzzi J.L.
        • Buros J.
        • Cannon C.P.
        Peripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial.
        Clin Cardiol. 2005; 28: 238-242
        • Mosca L.
        • Hammond G.
        • Mochari-Greenberger H.
        • et al.
        Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey.
        Circulation. 2013; 127: 1254-1263
        • Hirsch A.T.
        • Allison M.A.
        • Gomes A.S.
        • et al.
        A call to action: women and peripheral artery disease: a scientific statement from the American Heart Association.
        Circulation. 2012; 125: 1449-1472
        • Pendyala L.K.
        • Torguson R.
        • Loh J.P.
        • et al.
        Comparison of adverse outcomes after contemporary percutaneous coronary intervention in women versus men with acute coronary syndrome.
        Am J Cardiol. 2013; 111: 1092-1098