461Modulation of ischemic and bleeding risk by peripheral artery disease after an acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Cespon Fernandez ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
S Manzano-Fernandez ◽  
F Dascenzo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cumulative Incidence ◽  
Bleeding Risk ◽  
Peripheral Artery ◽  
Data Set ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with acute coronary syndrome (ACS). With this study from real-life patients, we try to analyze the balance between ischemic and bleeding risk during treatment with dual antiplatelet therapy (DAPT) after an ACS according to the presence or not of PAD. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without PAD. The impact of prior PAD in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,600 have PAD (6.1%). Patients with PAD were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with PAD in comparison with the rest of the population (8.2% vs 22.8%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. After propensity-score matching, we obtained two matched groups of 1,591 patients. Patients with PAD showed a significant higher risk of both AMI (sHR 2.17, 95% CI 1.51–3.10, p<0.001) and MB (sHR 1.51, 95% CI 1.07–2.12, p=0.018), in comparison with those without PAD. The cumulative incidence of AMI was 63.9 and 29.8 per 1,000 patients/year in patients with and without PAD, respectively. The cumulative incidence of MB was 55.9 and 37.6 per 1,000 patients/year in patients with and without PAD, respectively. The rate difference per 1,000 patient-years for AMI between patients with and without PAD was +34.1 (95% CI 30.1–38.1), and for MB +18.3 (16.1–20.4). The net balance between ischemic and bleeding events comparing patients with and without PAD was positive (+15.8 per 1,000 patients/year, 95% CI 9.7–22.0). Conclusions PAD was associated with higher ischemic and bleeding risk after hospital discharge for ACS treated with DAPT. However, the balance between ischemic and bleeding risk was positive for patients with PAD in comparison with patients without PAD. As summary, ACS patients with PAD had an ischemic risk greater than the bleeding risk.

scholarly journals Clinical impact of peripheral artery disease on acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Fonseca Goncalves ◽  
S.C Borges ◽  
J.J Monteiro ◽  
P.S Mateus ◽  
J.I Moreira
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Peripheral Artery Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Abstract Introduction Peripheral artery disease (PAD) and acute coronary syndrome (ACS) are two diseases with high morbidity and mortality and, sometimes, may be present simultaneously, making patient management more complex. Purpose This study sought to characterize and evaluate the prognostic impact of PAD in patients with an ACS. Methods This was a retrospective study of patients admitted with an ACS, periodically included in a national multicenter registry, between October 2010 and September 2019. Results Of a total of 26036 patients, 1429 had previous history of PAD. This group had a higher predominance of men (79,5% vs 72,0%, p&lt;0,001) and was older (71±11 years vs 66±14 years, p&lt;0,001). Besides having a higher burden of cardiovascular risk factors, they also had more past history of myocardial infarction (MI), stroke and chronic kidney disease. In patients with PAD, non-ST segment elevation MI was the most frequent type of MI (58,6% vs 45,0%, p&lt;0,001) and left ventricular ejection fraction assessed during hospitalization was lower (49±13% vs 51±12%, p&lt;0,001). These patients were submitted less frequently to a coronary angiography (74,0% vs 85,2%, p&lt;0,001) and, when performed, more cases of multivessel coronary artery disease were found (70,6% vs 50,4%, p&lt;0,001). Nevertheless, they were less likely to undergo revascularization, with fewer angioplasties performed (47,8% vs 64,7%, p&lt;0,001), despite the greater number of coronary artery bypass grafting (9,0% vs 6,0%, p&lt;0,001). Both during hospitalization and at discharge, ticagrelor, beta-blockers and ACE inhibitors were less prescribed in the PAD group. Statins prescription was also lower, but only at discharge. In a multivariate regression analysis, we found that, during hospitalization, the presence of PAD was associated with a significant higher risk of myocardial reinfarction (OR 1,90 (CI 1,18–3,06)) and death (OR 1,43 (CI 1,03–2,00)). In addition, there was a tendency for more strokes (OR 1,88 (CI 0,98–3,61)). During a 1-year follow-up, PAD was also independently associated with a significant increase in mortality (HR 1,50 (CI 1,16–1,95)). Conclusions PAD is a disease present in patients with a higher number of comorbidities and is associated with more severe coronary events. Nevertheless, these patients seem to receive less evidence-based therapy. In this study, PAD was independently associated with a significant increase in short and medium-term major adverse events. Kaplan-Meier curves of 1-year follow-up Funding Acknowledgement Type of funding source: None

scholarly journals Peripheral arterial disease: Changes in clinical outcomes and therapeutic strategies in two cohorts, from 2002 to 2008 and from 2008 to 2014. A population-based study

2018 ◽  
Vol 25 (16) ◽  
pp. 1735-1743 ◽  
Author(s):  
Marta Baviera ◽  
Vittorio Bertelè ◽  
Fausto Avanzini ◽  
Tommaso Vannini ◽  
Mauro Tettamanti ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Peripheral Artery Disease ◽  
Cardiovascular Prevention ◽  
Lipid Lowering ◽  
Peripheral Artery ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Artery Disease

Background The aim of our study was to evaluate whether treatments for peripheral artery disease changed in two different cohorts identified in 2002 and 2008, and whether this had an impact on mortality and major clinical outcomes after six years of follow-up. Methods Using administrative health databases of the largest region in Northern Italy, we identified patients admitted to hospital for peripheral artery disease in 2002 and 2008. Both cohorts were followed for six years. All cause death, acute coronary syndrome, stroke and major amputations, cardiovascular prevention drugs and revascularization procedures were collected. Incidence of events was plotted using adjusted cumulative incidence function estimates. The risk, for each outcome, was compared between 2002–2008 and 2008–2014 using a multivariable Fine and Gray’s semiparametric proportional subdistribution hazards model. Results In 2002 and 2008, 2885 and 2848 patients were identified. Adjusting for age, sex, Charlson comorbidity index and severity of peripheral artery disease we observed a significant reduction (in 2008 vs. 2002) in the risk of acute coronary syndrome (28%), stroke (27%) and major amputation (17%). No change was observed in the risk of death. The percentages of patients with peripheral artery revascularizations, during the hospital stay, increased: 43.8% in 2002 vs. 49.0% in 2008, p < 0.001. From 2002 to 2008 there was a significant absolute increase in the prescription of lipid-lowering drugs (+18%), antiplatelets (+7.2%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (+11.8%), p < 0.001. Conclusions In six years of follow-up we observed a reduction in risk of major cardiovascular events in 2008–2014 in comparison with the 2002–2008 cohort. Increasing use of revascularization interventions and cardiovascular prevention drugs could have contributed to the better prognosis.

Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk

Vascular ◽  
2020 ◽  
pp. 170853812093892 ◽  
Author(s):  
Carlos Cantú-Brito ◽  
Erwin Chiquete ◽  
Javier F Antezana-Castro ◽  
Liz Toapanta-Yanchapaxi ◽  
Ana Ochoa-Guzmán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Case Fatality ◽  
Coronary Risk ◽  
Vascular Risk ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Objectives The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. Methods We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). Results ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% ( p =  0.27) and 5.4% ( p =  0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. Conclusions Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

scholarly journals PERIPHERAL ARTERY DISEASE, ABNORMAL ANKLE-BRACHIAL INDEX AND PROGNOSIS AFTER ACUTE CORONARY SYNDROME

2020 ◽  
Vol 75 (11) ◽  
pp. 7
Author(s):  
Anat Berkovitch ◽  
Zaza Iakobishvili ◽  
Shmuel Fuchs ◽  
Shaul Atar ◽  
Omri Braver ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Artery Disease

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

2019 ◽  
Vol 28 (5) ◽  
pp. 410-417 ◽  
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.

Incidence, timing, and type of first and recurrent ischemic events in patients with and without peripheral artery disease after an acute coronary syndrome

2018 ◽  
Vol 201 ◽  
pp. 25-32 ◽  
Author(s):  
Taku Inohara ◽  
Karen Pieper ◽  
Daniel M. Wojdyla ◽  
Manesh R. Patel ◽  
William Schuyler Jones ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Ischemic Events

scholarly journals Relation of contrast volume to new onset atrial fibrillation in acute coronary syndrome underwent percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Cespon Fernandez ◽  
E Abu-Assi ◽  
J.A Parada Barcia ◽  
A Lizancos Castro ◽  
B Caneiro Queija ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Cumulative Incidence ◽  
Total Study Population ◽  
Contrast Dose ◽  
Coronary Syndrome ◽  
Important Relationship ◽  
Contrast Volume ◽  
The Impact

Abstract Introduction There is an important relationship between atrial fibrillation (AF) and contrast induced nephropathy (CIN). Several hypotheses were suggested to explain this unidirectional association between CIN and AF, like influence on renin-angiotensin-aldosterone system and the inflammatory pathway, as well as the use of iodinated contrasts -due to its possible interaction at the thyroid hormone regulation-. Purpose The aim of this study was to analyze the relation between contrast volume and the subsequent development of AF in patients with acute coronary syndrome (ACS) Methods A total of 6,133 ACS patients underwent PCI between 2010 and 2016 were analyzed. We have excluded 1,896 patients with prior history of AF, without data about contrast volume or with missing data about follow-up. The impact of contrast volume in the development of AF was assessed by Cox regression analysis. Hazard Ratios (HR) with 95% of confidence interval (CI) were reported. Maximum allowable contrast dose (MACD) was defined as 5*body weight/serum creatinine. Results From the total study population (4,237 patients, 64.3±12.8 years, 24.2% women), 399 (9.4%) developed AF during a mean follow-up of 3.5±2.4 years. Mean contrast volume used was 199.9±90.3 ml. Contrast volume was not associated with follow-up de novo AF (HR 0.99, 95% CI: 0.99–1.00; p=0.834). However, the ratio between contrast volume used and the maximum allowable contrast dose (CV/MACD) resulted a predictor of follow-up AF (HR 1.18, 95% CI: 1.02–1.37, p=0.027). The cumulative incidence of AF was 2.7 per 100 patients/year in patients with CV/MACD ≤1 and 4.8 per 100 patients/year in patients with CV/MACD &gt;1. After adjusting for those variables associated with follow-up AF in the univariate analysis, the use of a contrast volume higher than MACD resulted an independent predictor of AF (HR 1.40, 95% CI: 1.03–1.89; p=0.032). Conclusion Doses of contrast volume higher than the maximum allowable contrast dose were independently associated with higher rates of AF during the follow-up. Cumulative incidence of AF by groups Funding Acknowledgement Type of funding source: None

scholarly journals Specific plasma oxylipins increase the odds of cardiovascular and cerebrovascular events in patients with peripheral artery disease

2017 ◽  
Vol 95 (8) ◽  
pp. 961-968 ◽  
Author(s):  
Stephanie P.B. Caligiuri ◽  
Harold M. Aukema ◽  
Amir Ravandi ◽  
Renée Lavallée ◽  
Randy Guzman ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Fatty Acids ◽  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Therapeutic Targets ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Cerebrovascular Events ◽  
Prostaglandin F ◽  
Artery Disease

Oxylipins and fatty acids may be novel therapeutic targets for cardiovascular disease. The objective was to determine if plasma oxylipins or fatty acids can influence the odds of cardiovascular/cerebrovascular events. In 98 patients (25 female, 73 male) with peripheral artery disease, the prevalence of transient ischemic attacks, cerebrovascular accidents, stable angina, and acute coronary syndrome was n = 16, 10, 16, and 24, respectively. Risk factors such as being male, diagnosed hypertension, diabetes mellitus, and hyperlipidemia were not associated with events. Plasma fatty acids and oxylipins were analyzed with gas chromatography and HPLC-MS/MS, respectively. None of 24 fatty acids quantified were associated with events. In contrast, 39 plasma oxylipins were quantified, and 8 were significantly associated with events. These 8 oxylipins are known regulators of vascular tone. For example, every 1 unit increase in Thromboxane B2/Prostaglandin F1α and every 1 nmol/L increase in plasma 16-hydroxyeicosatetraenoic acid, thromboxane B2, or 11,12-dihydroxyeicosatrienoic acid (DiHETrE) increased the odds of having had ≥2 events versus no event (p < 0.05). The greatest predictor was plasma 8,9-DiHETrE, which increased the odds of acute coronary syndrome by 92-fold. In conclusion, specific oxylipins were highly associated with clinical events and may represent specific biomarkers and (or) therapeutic targets of cardiovascular disease.

scholarly journals The Costs and Cardiovascular Benefits in Patients with Peripheral Artery Disease Receiving a Fourth-Generation Synchronous Telehealth Program (Preprint)

2020 ◽  
Author(s):  
Jenkuang Lee ◽  
Chi-Sheng Hung ◽  
Ching-Chang Huang ◽  
Ying-Hsien Chen ◽  
Hui-Wen Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Cardiovascular Events ◽  
Control Group ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Artery Disease

BACKGROUND Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events (MACE), including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a 4th-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. OBJECTIVE The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the 4th-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with the diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization (HFH), acute coronary syndrome (ACS), stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. RESULTS The mean follow-up duration was 3.1 ± 1.8 years for the patients who participated in the telehealth program and 3.2 ± 1.8 years for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than the control group in the first year after IPTW (0.9% vs. 3.5%; hazard ratio [HR] 0.24, 95% CI 0.07–0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs. 5.2%; [HR] 0.46, 95% CI 0.21–0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than the control group after IPTW (0.9% vs. 3.5%; [HR] 0.52, 95% CI 0.28–0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. CONCLUSIONS The PAD patients who participated in the 4th-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger scale and prospective randomized clinical trials are needed to confirm our findings.

Sign in / Sign up

Export Citation Format

Share Document