Key result
Extensive systemic atherosclerosis after acute MI was associated with a higher risk of all-cause mortality compared to limited systemic atherosclerosis (adjusted HR 1.8; 95% CI 1.1-3.0; P=0.019).
Why the study?
Does extensive systemic atherosclerosis predict worse outcomes in acute MI patients compared to limited systemic atherosclerosis?
Cohort (n=544)
Does extensive systemic atherosclerosis predict worse outcomes in acute MI patients compared to limited systemic atherosclerosis?
Hazard Ratio: 1.8 (95% CI 1.1–3)
p-value: p=0.019
Coexistence of extensive coronary disease and extra-cardiac artery disease defines a group with particularly poor prognosis after myocardial infarction.
May refine post-MI risk stratification; leaves open whether atherosclerosis extent is a modifiable target.
BACKGROUND: The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis. METHODS AND RESULTS: The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02-1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES ≥ 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9-4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1-3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1-4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2-3.1, P < 0.004). CONCLUSIONS: Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.
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Calais et al. (2018) conducted a cohort in Acute myocardial infarction (n=544). Extensive systemic atherosclerosis (extensive coronary disease and extra-cardiac artery disease) vs. Limited systemic atherosclerosis (limited coronary disease and no extra-cardiac artery disease) was evaluated on All-cause mortality (adjusted HR 1.8, 95% CI 1.1-3.0, p=0.019). Extensive systemic atherosclerosis after acute MI was associated with a higher risk of all-cause mortality compared to limited systemic atherosclerosis (adjusted HR 1.8; 95% CI 1.1-3.0; P=0.019).
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