The impact of peripheral artery disease on major adverse cardiovascular events following myocardial infarction

Patients with peripheral artery disease (PAD) are at heightened risk for ischemic events related to atherothrombosis. Antithrombotic therapies can reduce the risk of atherothrombotic events but increase bleeding. Importantly, there is growing appreciation of the heterogeneity in risk profile and effect of antithrombotic therapies in different populations, including those with PAD. Further, patients with PAD are at risk for not only major adverse cardiovascular events but also major adverse limb events, and the drivers of risk for each are different. Within PAD populations, data from trials may be difficult to interpret due to differences among the studies with regards to patient population, clinical settings, and outcomes examined. The acute setting of peripheral revascularization which involves plaque rupture and endothelial disruption confers very high risk of major adverse limb events early postprocedure. Among patients with chronic PAD for whom the goal of antithrombotic therapy is secondary prevention, concomitant coronary artery disease, particularly with prior myocardial infarction, is associated with greatest risk for major adverse cardiovascular events, while prior peripheral revascularization or amputation is associated with greatest risk for major adverse limb events. Understanding of the potential impact of clinical setting and patient risk profile is important to guide evidence-based decisions regarding antithrombotic therapy in patients with PAD. In this article, we provide a contemporary review of data supporting the use of antithrombotic therapy in PAD, as well as a clinical framework for analysis and translation of these data into practice, highlighting areas in need of further investigation.

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Asymmetric Dimethylarginine Predicts Major Adverse Cardiovascular Events in Patients With Advanced Peripheral Artery Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/01.atv.0000242801.38419.48 ◽

2006 ◽

Vol 26 (11) ◽

pp. 2536-2540 ◽

Cited By ~ 99

Author(s):

Friedrich Mittermayer ◽

Katarzyna Krzyzanowska ◽

Markus Exner ◽

Wolfgang Mlekusch ◽

Jasmin Amighi ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Asymmetric Dimethylarginine ◽

Major Adverse Cardiovascular Events ◽

Peripheral Artery ◽

Artery Disease

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Aspirin Resistance Predicts Adverse Cardiovascular Events in Patients with Symptomatic Peripheral Artery Disease

Texas Heart Institute Journal ◽

10.14503/thij-14-4986 ◽

2016 ◽

Vol 43 (6) ◽

pp. 482-487 ◽

Cited By ~ 5

Author(s):

Tilak Pasala ◽

Jennifer Soo Hoo ◽

Mary Kate Lockhart ◽

Rehan Waheed ◽

Prasanna Sengodan ◽

...

Keyword(s):

Myocardial Infarction ◽

Peripheral Artery Disease ◽

Primary Endpoint ◽

Cardiovascular Events ◽

Aspirin Resistance ◽

Secondary Outcome ◽

Peripheral Artery ◽

Significant Difference ◽

Artery Disease

Antiplatelet therapy reduces the risk of myocardial infarction, stroke, and vascular death in patients who have symptomatic peripheral artery disease. However, a subset of patients who take aspirin continues to have recurrent cardiovascular events. There are few data on cardiovascular outcomes in patients with peripheral artery disease who manifest aspirin resistance. Patients with peripheral artery disease on long-term aspirin therapy (≥4 wk) were tested for aspirin responsiveness by means of the VerifyNow Aspirin Assay. The mean follow-up duration was 22.6 ± 8.3 months. The primary endpoint was a composite of death, myocardial infarction, or ischemic stroke. Secondary endpoints were the incidence of vascular interventions (surgical or percutaneous), or of amputation or gangrene caused by vascular disease. Of the 120 patients enrolled in the study, 31 (25.8%) were aspirin-resistant and 89 (74.2%) were aspirin-responsive. The primary endpoint occurred in 10 (32.3%) patients in the aspirin-resistant group and in 13 (14.6%) patients in the aspirin-responsive group (hazard ratio=2.48; 95% confidence interval, 1.08–5.66; P=0.03). There was no significant difference in the secondary outcome of revascularization or tissue loss. By multivariate analysis, aspirin resistance and history of chronic kidney disease were the only independent predictors of long-term adverse cardiovascular events. Aspirin resistance is highly prevalent in patients with symptomatic peripheral artery disease and is an independent predictor of adverse cardiovascular risk. Whether intervening in these patients with additional antiplatelet therapies would improve outcomes needs to be explored.

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Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes

World Journal of Diabetes ◽

10.4239/wjd.v12.i6.883 ◽

2021 ◽

Vol 12 (6) ◽

pp. 883-892

Author(s):

Jonathan Golledge ◽

Aaron Drovandi ◽

Sophie Rowbotham ◽

Ramesh Velu ◽

Frank Quigley ◽

...

Keyword(s):

Risk Factors ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Modifiable Risk Factors ◽

Peripheral Artery ◽

Artery Disease

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CYP2C19 status and risk of major adverse cardiovascular events in peripheral artery disease: Insights from the EUCLID Trial

American Heart Journal ◽

10.1016/j.ahj.2020.07.017 ◽

2020 ◽

Vol 229 ◽

pp. 118-120

Author(s):

J. Antonio Gutierrez ◽

Gretchen M. Heizer ◽

W. Schuyler Jones ◽

Frank W. Rockhold ◽

Kenneth W. Mahaffey ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Peripheral Artery ◽

Artery Disease

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Data on the impact of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events

Data in Brief ◽

10.1016/j.dib.2018.10.153 ◽

2018 ◽

Vol 21 ◽

pp. 1716-1720 ◽

Cited By ~ 2

Author(s):

Christoph H. Saely ◽

Marc Schindewolf ◽

Daniela Zanolin ◽

Christine F. Heinzle ◽

Alexander Vonbank ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Peripheral Artery ◽

Artery Disease ◽

The Impact

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Association between Peripheral Artery Disease and Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome: Findings from the Gulf COAST Registry

Medical Principles and Practice ◽

10.1159/000497790 ◽

2019 ◽

Vol 28 (5) ◽

pp. 410-417 ◽

Cited By ~ 1

Author(s):

Ibrahim Al-Zakwani ◽

Ekram Al Siyabi ◽

Najib Alrawahi ◽

Arif Al-Mulla ◽

Abdullah Alnaeemi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Arabian Gulf ◽

Major Adverse Cardiovascular Events ◽

Peripheral Artery ◽

Coronary Syndrome ◽

Vascular Insufficiency ◽

All Cause Mortality ◽

Artery Disease

Objective: To evaluate the association between peripheral artery disease (PAD) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Methods: Data from 4,044 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013 were analyzed. PAD was defined as any of the following: claudication, amputation for arterial vascular insufficiency, vascular reconstruction, bypass surgery, or percutaneous intervention in the extremities, documented aortic aneurysm or an ankle brachial index of <0.8 in any of the legs. MACE included stroke/transient ischemic attack (TIA), myocardial infarction (MI), all-cause mortality, and readmissions for cardiac reasons diagnosed between hospital admission and at 1-year post discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years and 66% (n = 2,686) were males. A total of 3.3% (n = 132) of the patients had PAD. Patients with PAD were more likely to be associated with smoking, prior MI, hypertension, diabetes mellitus, and stroke/TIA. At the 1-year follow-up, patients with PAD were significantly more likely to have MACE (adjusted OR [aOR], 2.07; 95% confidence interval [CI]: 1.41–3.06; p< 0.001). The higher rates of events were also observed across all MACE components; stroke/TIA (aOR, 3.22; 95% CI: 1.80–5.75; p< 0.001), MI (aOR, 2.15; 95% CI: 1.29–3.59; p =0.003), all-cause mortality (aOR, 2.21; 95% CI: 1.33–3.69; p =0.002), and readmissions for cardiac reasons (aOR, 1.83; 95% CI: 1.24–2.70; p =0.003). Conclusions: PAD was significantly associated with MACE in ACS patients in the Arabian Gulf.

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Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID

Journal of the American Heart Association ◽

10.1161/jaha.120.018684 ◽

2021 ◽

Author(s):

Marc D. Samsky ◽

Anne Hellkamp ◽

William R. Hiatt ◽

F. Gerry R. Fowkes ◽

Iris Baumgartner ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Peripheral Artery ◽

Factors Associated ◽

Artery Disease

Background Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new‐onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown. Methods and Results This analysis examined risk relationships of HF on outcomes in patients with symptomatic PAD randomized to ticagrelor or clopidogrel as part of the EUCLID (Examining Use of Ticagrelor in Peripheral Arterial Disease) trial. Patients were stratified based on presence of HF at enrollment. Cox models were used to determine the association of HF with outcomes. A separate Cox model was used to identify risk factors associated with development of HF during follow‐up. Patients with PAD and HF had over twice the rate of concomitant coronary artery disease as those without HF. Patients with PAD and HF had significantly increased risk of major adverse cardiovascular events (hazard ratio [HR], 1.31; 95% CI, 1.13–1.51) and all‐cause mortality (HR, 1.39; 95% CI, 1.19–1.63). In patients with PAD, the presence of HF was associated with significantly less bleeding (HR, 0.65; 95% CI, 0.45–0.96). Characteristics associated with HF development included age ≥66 (HR, 1.29; 95% CI, 1.18–1.40 per 5 years), diabetes mellitus (HR, 1.85; 95% CI, 1.41–2.43), and weight (bidirectionally associated, ≥76 kg, HR, 0.77; 95% CI, 0.64–0.93; <76 kg, HR, 1.12; 95% CI, 1.07–1.16). Conclusions Patients with PAD and HF have a high rate of coronary artery disease with a high risk for major adverse cardiovascular events and death. These data support the possible need for aggressive treatment of (recurrent) atherosclerotic disease in PAD, especially patients with HF.

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