Key result
Polyvascular disease in ACS linked to ~45% greater 5-year MACCE risk.
Why the study?
Data on the impact of polyvascular disease on long-term prognosis in patients with CAD were scarce.
Does the presence of polyvascular disease increase the risk of 5-year MACCE in patients with acute coronary syndrome?
Cohort (n=342,052)
Yes
Does the presence of polyvascular disease increase the risk of 5-year MACCE in patients with acute coronary syndrome?
Effect estimate: HR 1.45 (95% CI 1.40-1.50)
In patients with acute coronary syndrome, the presence of polyvascular disease significantly and progressively increases the risk of long-term major adverse cardiovascular and cerebrovascular events.
May warrant closer monitoring in ACS with polyvascular disease; extends observational data on incremental long-term risk.
Background: Atherothrombosis is a systemic disease that may affect one or more than one vascular bed. Data on the impact of polyvascular disease (PVD) on the long-term prognosis of patients with coronary artery disease (CAD) are still scarce. Aim: To assess the prevalence of symptomatic PVD in a cohort of patients with a new episode of acute coronary syndrome (ACS) and to investigate the impact of multiple vascular beds involvement on long-term outcomes. Methods: We analysed a nationwide, comprehensive administrative database of consecutive patients aged ≥ 40 years admitted for a new episode of ACS in Italy in 2017–2018. Patients with ACS were stratified according to the presence of peripheral artery disease (PAD) only; cerebrovascular disease (CeVD) only; PAD+CeVD; or neither (no PAD/noCeVD, i.e., ACS only). A multivariate Cox proportional hazards model was used to assess the impact of PAD only; CeVD only and PAD+CeVD on 5-year MACCE. Results: A total of 342,052 patients hospitalised with ACS were identified. Among them, 24,727 (7.2%) were patients with PAD only, 16,887 (4.9%) with CeVD only, and 5810 (1.7%) with PAD+CeVD. After adjusting for age, sex, and comorbidities, the hazard ratio (HR) for 5-year MACCE was 1.37 (95% CI: 1.35–1.40), 1.36 (95% CI: 1.33–1.39), and 1.45 (95% CI: 1.40–1.50) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, compared with patients with ACS only. Conclusions: In patients with ACS, the involvement of a second vascular bed increases the risk of long-term outcomes; the simultaneous involvement of three vascular beds further increases the risk of long-term outcomes.
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Mureddu et al. (2025) conducted a cohort in Acute Coronary Syndrome (n=342,052). Polyvascular disease (PAD and/or CeVD) vs. ACS only (no PAD or CeVD) was evaluated on 5-year MACCE (HR 1.45, 95% CI 1.40-1.50). In patients with ACS, the presence of polyvascular disease (PAD+CeVD) significantly increased the risk of 5-year MACCE compared to ACS alone (HR 1.45; 95% CI 1.40-1.50).
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