Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes
Key result
Prior polyvascular disease in three arterial beds is linked to ~31% higher in-hospital ischemic risk.
- OR 1.31
- P<0.001
- n=95,749
Why the study?
PAD or CVD is associated with higher likelihood of significant CAD, but the prevalence and impact of pre-existent polyvascular disease in non-ST-segment elevation ACS needed assessment.
Does prior polyvascular disease increase the risk of in-hospital adverse events in patients presenting with non-ST-segment elevation acute coronary syndrome?
Population
95 749 patients presenting with non-ST-segment elevation ACS at 484 sites
Comparison
Prior 1, 2, or 3 affected arterial beds vs 0 affected arterial beds
Design
Multicentre registry analysis
Follow-up
In-hospital
Authors
Discussion
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Member takes
Implication
Polyvascular disease flags higher-risk NSTE-ACS patients; leaves open whether intensified therapy improves outcomes.
Key Points
- To assess the prevalence of pre-existing polyvascular disease across multiple arterial territories in patients presenting with non-ST-segment elevation acute coronary syndrome and evaluate its impact on adverse in-hospital outcomes.
- Analyzed clinical data from N=95,749 patients enrolled across 484 sites from February 2003 to September 2006 in the CRUSADE registry.
- Categorized patients by the number of prior affected arterial beds (0, 1, 2, or 3) across peripheral arterial disease, cerebrovascular disease, and coronary artery disease.
- Evaluated in-hospital mortality, myocardial infarction, stroke, congestive heart failure, non-bypass red blood cell transfusions, and major bleeding.
- Prior involvement of 0, 1, 2, and 3 arterial beds occurred in 48.9% (95% CI 48.6–49.2%), 38.3% (95% CI 37.8–39.0%), 11.2% (95% CI 10.9–11.9%), and 1.6% (95% CI 1.5–1.8%) of patients, respectively.
- Adjusted odds ratios for composite in-hospital ischaemic events progressively increased from 1.07 to 1.26 to 1.31 across 1, 2, and 3 diseased arterial beds compared to 0 beds (P < 0.001).
- Adjusted odds ratios for red blood cell transfusion increased with disease burden from 1.11 to 1.28 to 1.30 across 1, 2, and 3 beds (P < 0.001), while adjusted rates of protocol-defined non-bypass major bleeding did not.
Study Design
Type
Cohort (n=95,749)
Multicenter
Yes
Structured PICO
Does prior polyvascular disease increase the risk of in-hospital adverse events in patients presenting with non-ST-segment elevation acute coronary syndrome?
P
Population
95,749 patients presenting with non-ST-segment elevation acute coronary syndrome enrolled in the CRUSADE registry.
E
Exposure
Pre-existent disease in 1, 2, or 3 arterial beds (prior coronary artery disease, peripheral arterial disease, or cerebrovascular disease)
C
Comparator
0 prior affected arterial beds
O
Outcome
Composite of in-hospital ischaemic eventscomposite
Main Result
Odds Ratio: 1.31
p-value: p=<0.001
In patients with non-ST-segment elevation acute coronary syndrome, the presence of prior polyvascular disease is associated with a stepwise increase in the risk of in-hospital ischemic events and mortality.
Cite This Study
Bhatt et al. (2009) conducted a cohort in Non-ST-segment elevation acute coronary syndrome (n=95,749). Prior polyvascular disease (1, 2, or 3 affected arterial beds) vs. 0 affected arterial beds was evaluated on Composite of in-hospital ischaemic events (OR 1.31, p=<0.001). Prior polyvascular disease in 1, 2, or 3 arterial beds increased the risk of in-hospital ischaemic events compared with 0 arterial beds (OR increasing from 1.07 to 1.31; P<0.001).